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Rheumatoid Arthritis

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Pulmonary Manifestations of Rheumatic Disease

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Abstract

Rheumatoid arthritis (RA) is an autoimmune-mediated joint disease that leads to chronic inflammation of the synovium with destruction of cartilage and bone. It is also a systemic disorder with a wide range of extraarticular manifestations. Smoking increases the risk of RA as well as RA-related lung disease. Pulmonary manifestations in RA can involve any of the intrathoracic compartments including the lung parenchyma, airways, pleura, and the pulmonary vasculature. Parenchymal lung disease consists of interstitial lung disease (ILD) and rheumatoid lung nodules. The most common histopathologic patterns underlying ILD in RA are usual interstitial pneumonia and nonspecific interstitial pneumonia. Rheumatoid lung nodules can be confused for malignancy. Airway diseases include cricoarytenoiditis, bronchiectasis, and small airways disease including constrictive bronchiolitis which can cause progressive airflow obstruction resulting in respiratory failure. Other forms of intrathoracic involvement include pleuritis, pleural effusion, and pulmonary vasculitis. In addition, drug-induced lung disease and pulmonary infections are relatively common in this patient population. Appropriate management of pulmonary disease in patients with RA depends on identifying the exact nature of the pulmonary involvement and its severity as well as the underlying cause and individual patient context.

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Gonda 18 South, Mayo Clinic, 200 1st Street, SW, Rochester, MN, 55905, USA

    Jay H. Ryu M.D.

  2. Division of Rheumatology, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA

    Eric L. Matteson M.D., M.P.H.

  3. Division of Epidemiology, Department of Health Science Research, Mayo Clinic College of Medicine, 200 1st Street, SW, Rochester, MN, 55905, USA

    Eric L. Matteson M.D., M.P.H.

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  1. Jay H. Ryu M.D.
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Correspondence to Jay H. Ryu M.D. .

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Editors and Affiliations

  1. Harvard Medical School, Department of Medicine, Division of Rheumatology Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Paul F. Dellaripa

  2. Division of Rheumatology, Autoimmune and Interstitial Lung Disease Program, Department of Medicine, National Jewish Health, Denver, Colorado, USA

    Aryeh Fischer

  3. Department of Internal Medicine, Division of Pulmonary/Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA

    Kevin R. Flaherty

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Ryu, J.H., Matteson, E.L. (2014). Rheumatoid Arthritis. In: Dellaripa, P., Fischer, A., Flaherty, K. (eds) Pulmonary Manifestations of Rheumatic Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0770-0_3

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