Skip to main content
The Egyptian Journal of Bronchology
Download PDF
  • Original article
  • Open access
  • Published:

Evaluation of carbon monoxide diffusing capacity as an early detection of pulmonary involvement in rheumatoid arthritis patients without respiratory symptoms

Egyptian Journal of Bronchology volume 8, pages 167–172 (2014)Cite this article

Abstract

Background

The risk of death for rheumatoid arthritis (RA) patients with interstitial lung disease (ILD) is three times higher than that in RA patients free from ILD. Therefore, this study was carried out to assess the value of carbon monoxide diffusing capacity (DLCO) in the early detection of pulmonary involvement in RA.

Patients and methods

This prospective study was carried out in 30 nonsmoker patients with RA (29 women and one men) ranging in age from 21 to 66 years, mean age 42.6 ± 1.9 years. All RA patients were clinically free from respiratory symptoms with normal chest radiograph. For all patients, spirometry and DLCO were performed.

Results

Twenty (66.67%) cases had a diffusion defect in DLCO; the defect was mild in 17 cases and moderate in three cases. The severity of DLCO differed significantly with the duration of RA and decrease in forced vital capacity (P < 0.05), but did not differ significantly with either the rheumatoid factor titer or the duration of methotrexate therapy (P > 0.05), although the use of methotrexate was higher among patients with abnormal DLCO. The severity of DLCO correlated significantly and inversely with the duration of RA (P < 0.05). A normal pattern of spirometry was the predominant pattern, followed by a restrictive pattern and small airway obstruction, whereas the obstructive pattern was the least observed.

Conclusion

There is a high incidence of pulmonary involvement in RA patients, especially in those receiving methotrexate therapy. Pulmonary function testing, and more specifically DLCO, can serve as useful screening tools for the early detection of RA-ILD even in clinically asymptomatic patients with normal chest radiograph.

References

  1. Fleischmann R, Kremer J, Cush J, Schulze-Koops H, Connell CA, Bradley JD, et al. ORAL Solo Investigators Placebo-controlled trial of tofacitinib monotherapy in rheumatoid arthritis. N Engl J Med 2012; 367:495–507.

    Article  CAS  Google Scholar 

  2. Hamblin MJ, Horton MR. Rheumatoid arthritis-associated interstitial lung disease: diagnostic dilemma. Pulm Med 2011; 2011:872120.

    Article  Google Scholar 

  3. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO III, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010; 62:2569–2581.

    Article  Google Scholar 

  4. Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, et al. ATS/ERS Task Force General considerations for lung function testing. Eur Respir J 2005; 26:153–161.

    Article  CAS  Google Scholar 

  5. Macintyre N, Crapo RO, Viegi G, Johnson DC, van der Grinten CP, Brusasco V, et al. Standardisation of the single-breath determination of carbon monoxide uptake in the lung. Eur Respir J 2005; 26:720–735.

    Article  CAS  Google Scholar 

  6. Chen J, Shi Y, Wang X, Huang H, Ascherman D. Asymptomatic preclinical rheumatoid arthritis-associated interstitial lung disease. Clin Dev Immunol 2013; 2013:406927.

    PubMed  PubMed Central  Google Scholar 

  7. Bongartz T, Nannini C, Medina-Velasquez YF, Achenbach SJ, Crowson CS, Ryu JH, et al. Incidence and mortality of interstitial lung disease in rheumatoid arthritis: a population-based study. Arthritis Rheum 2010; 62:1583–1591.

    Article  Google Scholar 

  8. Gochuico BR, Avila NA, Chow CK, Novero LJ, Wu HP, Ren P, et al. Progressive preclinical interstitial lung disease in rheumatoid arthritis. Arch Intern Med 2008; 168:159–166.

    Article  CAS  Google Scholar 

  9. Fitting JW. Transfer factor for carbon monoxide: a glance behind the seen. Swiss Med Wkly 2004; 134:413–418.

    PubMed  Google Scholar 

  10. Ahlmén M, Svensson B, Albertsson K, Forslind K, Hafström I. BARFOT Study Group Influence of gender on assessments of disease activity and function in early rheumatoid arthritis in relation to radiographic joint damage. Ann Rheum Dis 2010; 69:230–233.

    Article  Google Scholar 

  11. Youssef AA, Machaly SA, El-Dosoky ME, El-Maghraby NM. Respiratory symptoms in rheumatoid arthritis: relation to pulmonary abnormalities detected by high-resolution CT and pulmonary functional testing. Rheumatol Int 2012; 32:1985–1995.

    Article  Google Scholar 

  12. Sakai M, Kitamura H, Nagata N. Lung function in patients with collagen vascular diseases: a study of non-smokers with normal chest roentgenograms. Intern Med 1993; 32:365–369.

    Article  CAS  Google Scholar 

  13. Gabazza E, Taguchi O, Yamakami T, Machishi M, Ibata H, Suzuki S. Usefulness of DLco for the early diagnosis of pulmonary involvement in collagen diseases. Nihon Kyobu Shikkan Gakkai Zasshi 1993; 31:480–485.

    CAS  PubMed  Google Scholar 

  14. Provenzano G. Asymptomatic pulmonary involvement in RA. Thorax 2002; 57:187–188.

    Article  CAS  Google Scholar 

  15. Gabbay E, Tarala R, Will R, Carroll G, Adler B, Cameron D, Lake FR. Interstitial lung disease in recent onset rheumatoid arthritis. Am J Respir Crit Care Med 1997; 156:528–535.

    Article  CAS  Google Scholar 

  16. Karazincir S, Akoğlu S, Güler H, Balci A, Babayiğit C, Eğilmez E, et al. The evaluation of early pulmonary involvement with high resolution computerized tomography in asymptomatic and non-smoker patients with rheumatoid arthritis. Tuberk Toraks 2009; 57:14–21.

    PubMed  Google Scholar 

  17. Kanat F, Levendoglu F, Teke T. Radiological and functional assessment of pulmonary involvement in the rheumatoid arthritis patients. Rheumatol Int 2007; 27:459–466.

    Article  Google Scholar 

  18. Yin Y, Liang D, Zhao L, Li Y, Liu W, Ren Y, et al. Anti-cyclic citrullinated peptide antibody is associated with interstitial lung disease in patients with rheumatoid arthritis. PLoS One 2014; 9: e92449.

    Article  Google Scholar 

  19. Dawson JK, Fewins HE, Desmond J, Lynch MP, Graham DR. Fibrosing alveolitis in patients with rheumatoid arthritis as assessed by high resolution computed tomography, chest radiography, and pulmonary function tests. Thorax 2001; 56:622–627.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Chest Diseases, Ain Shams University, Cairo, Egypt

    Mohammed A. Farrag, Rehab M. Mohammed MD, PhD & Mohammed F. El Bagalatya

  2. Department of Internal Medicine and Rheumatology, Ain Shams University, Cairo, Egypt

    Adel M. El-Sayed

Authors
  1. Mohammed A. Farrag
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adel M. El-Sayed
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rehab M. Mohammed MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohammed F. El Bagalatya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rehab M. Mohammed MD, PhD.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Farrag, M.A., El-Sayed, A.M., Mohammed, R.M. et al. Evaluation of carbon monoxide diffusing capacity as an early detection of pulmonary involvement in rheumatoid arthritis patients without respiratory symptoms. Egypt J Bronchol 8, 167–172 (2014). https://doi.org/10.4103/1687-8426.145721

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1687-8426.145721

Keywords