TY - JOUR
T1 - Characterisation of severe obliterative bronchiolitis in rheumatoid arthritis
AU - Devouassoux, G.
AU - Cottin, Vincent
AU - Liote, H.
AU - Marchand, E.
AU - Fraction, I.
AU - Schuller, A.
AU - Bejui-Thivolet, F.
AU - Cordier, Jean François
PY - 2009/5
Y1 - 2009/5
N2 - The characteristics of patients with rheumatoid arthritis (RA) who develop obliterative bronchiolitis characterised by severe airflow obstruction have been hitherto poorly investigated. A retrospective study of 25 patients with RA and functional evidence of obliterative bronchiolitis (forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) 50% and/or residual volume (RV)/total lung capacity (TLC).140% predicted) was conducted. Patients (mean + SD age 64 + 11 yrs) included 17 never-smokers and eight ex-smokers (10.5 + 5.4 pack-yrs). The diagnosis of RA preceded respiratory symptoms in 88% of cases. Dyspnoea on exertion was present in all patients and bronchorrhea in 44%. High-resolution computed tomography findings included: bronchial wall thickening (96%), bronchiectasis (40%), mosaic pattern (40%), centrilobular emphysema (56%), and reticular and/or ground-glass opacities (32%). Pulmonary function tests showed: FEV1 41+12% pred, FEV1/FVC 49 + 14%, FVC 70+ 20% pred, RV 148+ 68% pred and RV/TLC 142+ 34% pred. Lung biopsy, available in nine patients, demonstrated constrictive, follicular and mixed bronchiolitis. Patients were followed for 48.2+ 49 months. Treatment was poorly effective. Chronic respiratory failure occurred in 40% of patients, and four patients died. Obliterative bronchiolitis associated with rheumatoid arthritis is a severe and under-recognised condition leading to respiratory failure and death in a high proportion of patients.
AB - The characteristics of patients with rheumatoid arthritis (RA) who develop obliterative bronchiolitis characterised by severe airflow obstruction have been hitherto poorly investigated. A retrospective study of 25 patients with RA and functional evidence of obliterative bronchiolitis (forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) 50% and/or residual volume (RV)/total lung capacity (TLC).140% predicted) was conducted. Patients (mean + SD age 64 + 11 yrs) included 17 never-smokers and eight ex-smokers (10.5 + 5.4 pack-yrs). The diagnosis of RA preceded respiratory symptoms in 88% of cases. Dyspnoea on exertion was present in all patients and bronchorrhea in 44%. High-resolution computed tomography findings included: bronchial wall thickening (96%), bronchiectasis (40%), mosaic pattern (40%), centrilobular emphysema (56%), and reticular and/or ground-glass opacities (32%). Pulmonary function tests showed: FEV1 41+12% pred, FEV1/FVC 49 + 14%, FVC 70+ 20% pred, RV 148+ 68% pred and RV/TLC 142+ 34% pred. Lung biopsy, available in nine patients, demonstrated constrictive, follicular and mixed bronchiolitis. Patients were followed for 48.2+ 49 months. Treatment was poorly effective. Chronic respiratory failure occurred in 40% of patients, and four patients died. Obliterative bronchiolitis associated with rheumatoid arthritis is a severe and under-recognised condition leading to respiratory failure and death in a high proportion of patients.
KW - Airflow obstruction
KW - Bronchiectasis
KW - Emphysema
KW - Obliterative bronchiolitis
KW - Rheumatoid arthritis
KW - Small airways disease
UR - http://www.scopus.com/inward/record.url?scp=66749151978&partnerID=8YFLogxK
U2 - 10.1183/09031936.00091608
DO - 10.1183/09031936.00091608
M3 - Article
C2 - 19129282
AN - SCOPUS:66749151978
SN - 0903-1936
VL - 33
SP - 1053
EP - 1061
JO - European respiratory journal
JF - European respiratory journal
IS - 5
ER -