BOLESTI PLUĆA U REUMATOIDNOM ARTRITISU – ISKUSTVA TERCIJARNOG CENTRA

Ana Vodanović, Ivona Božić, Marin Petrić, Petra Šimac, Katarina Borić, Mislav Radić, Dijana Perković

Introduction. Rheumatoid arthritis (RA) is a systemic autoimmune disease, and its most common extra-articular manifestation is involvement of the lung parenchyma and pleura. The most common pleuropulmonary manifestation of RA is interstitial lung disease (ILD). The aim of this study was to show the frequency and characteristics of pleuropulmonary manifestations in patients with RA who were treated at the University Hospital Centre Split. Subjects and methods. Patients treated with biological and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) who were diagnosed with RA according to the 2010 EULAR/ACR classification criteria were included in the study. Data from the archive of medical records were analysed using the method of descriptive statistics. Results. A total of 188 patients with RA were analysed. There were 18 (9.6%) patients with pleuropulmonary manifestations of RA. The
average age was 66.5 (range: 48–85), and 13 of these patients were women (72.2%). 6 patients were smokers (33.3%). 12 patients were diagnosed with seropositive RA (66.6%), and four of these patients were smokers (33.3%). Patients with seropositive RA and associated pleuropulmonary manifestations had the shortest disease duration (<10 years), and there were five of them (83.3%), with four of them being smokers (66.6%). Nodular lung disease was found in 12 patients (66.6%), and 9 of these patients had seropositive RA (75%). Bronchiectasis was found in 8 patients (44.4%) and pleural thickening in three patients (16,6%). ILD was radiologically diagnosed in 10 patients (55.5%), and 7 of them had seropositive RA (70%). The pattern of usual interstitial pneumonia (UIP) was present in 8 patients (80%), while the pattern of non-specific interstitial pneumonia (NSIP) was found in two patients (20%). Conclusion. Patients with seropositive RA have a higher risk of developing nodular lung disease and ILD than patients with seronegative RA. The most common radiologically determined pattern of ILD was UIP, which coincides with data available from the literature.

Uvod. Reumatoidni artritis (RA) je sustavna autoimuna bolest čija je najčešća izvanzglobna manifestacija zahvaćanje plućnog parenhima i pleure. Najčešća pleuropulmonalna manifestacija RA je intersticijska bolest pluća (engl. interstitial lung disease, skr. ILD). Cilj istraživanja bio je prikazati učestalost i obilježja pleuropulmonalnih očitovanja u bolesnika s reumatoidnim artritisom liječenih u Kliničkom bolničkom centru Split. Ispitanici i metode. U istraživanje su uključeni bolesnici na biološkoj i ciljanoj sintetskoj terapiji antireumaticima koji mijenjaju tijek bolesti (engl. disease- modifying antirheumatic drugs, skr. DMARDs) s dijagnozom RA prema EULAR/ACR klasifikacijskim kriterijima iz 2010. godine. Analizirani su podatci iz arhive medicinske dokumentacije metodom deskriptivne statistike. Rezultati. Ukupno je analizirano 188 bolesnika s RA-om. Broj bolesnika s pleuropulmonalnim očitovanjima RA bio je 18 (9,6%). Prosječna životna dob bila je 66,5 godina (raspon: 48 – 85), od toga je 13 bilo žena (72,2%). Među oboljelima, šest ispitanika bili su pušači (33,3%), od čega ih je četiri ženskoga spola (66,6%). U dvanaest bolesnika dijagnosticiran je seropozitivni RA (66,6%), od kojih je četvero bilo pušača (33,3%). Bolesnici sa seropozitivnim RA-om i pridruženim pleuropulmonalnim očitovanjima imali su najkraće trajanje bolesti (<10 godina), a bilo ih je petero (83,3%), od čega je četvero bilo pušača (66,6%). Nodularna bolest pluća bila je utvrđena u dvanaest bolesnika (66,6%), a devet ih je imalo seropozitivni RA (75%). Bronhiektazije su nađene u osam bolesnika (44,4%) te zadebljanje pleure u tri bolesnika (16,6%). U deset bolesnika (55,5%) radiološki je utvrđena ILD, od čega ih je sedam imalo seropozitivni RA (70%). Uzorak uobičajene intersticijske pneumonije (UIP) bio je zastupljen u osam bolesnika (80%), dok je uzorak nespecifične intersticijske pneumonije (NSIP) utvrđen u dva bolesnika (20%). Zaključak. U bolesnika sa seropozitivnim RA-om utvrđena je veća prevalencija nodularne te intersticijske bolesti pluća, nego u seronegativnih bolesnika. Najčešći radiološki utvrđen uzorak ILD-a bio je UIP, što se poklapa s podatcima dostupnim iz literature.