Chest

Chest

Volume 93, Issue 1, January 1988, Pages 114-118
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Poor Prognosis in Patients with Rheumatoid Arthritis Hospitalized for Interstitial Lung Fibrosis

https://doi.org/10.1378/chest.93.1.114Get rights and content

Fifty-seven patients with rheumatoid arthritis (RA) were treated in hospital for diffuse interstitial lung fibrosis. Although interstitial fibrosis (either on the basis of lung function tests or chest roentgenograms or both) is fairly common among patients with RA, according to this study interstitial fibrosis of sufficient extent or severity to warrant hospitalization was rare: incidence of hospitalization due to the lung disease in RA patients was one case per 3,500 patient-years. Eight patients had a largely reversible lung disease associated with drug treatment (gold, D-penicillamine or nitrofurantoin.) The remaining 49 had interstitial fibrosis of unknown cause. Causes for hospitalization were respiratory and general symptoms in 38, but infiltrations on routine chest roentgenographic examinations alone in eleven patients. Forty-five out of the 49 patients had crackles on auscultation. The most typical findings in lung function tests were restriction and a decreased diffusion capacity. These 49 patients showed a poor prognosis, with a median survival of 3.5 years and a five-year survival rate of 39 percent.

Section snippets

Patients

All RA patients hospitalized for interstitial lung fibrosis (diagnostic code 517.01-.0912) in the years 1978-1982, according to the Hospital Discharge Register which contains data on all hospitalizations in Finland, were included in the study. Twenty-one patients were excluded, eight who did not fulfill the criteria for classic or definite RA,13 and 13 in whom the diagnosis of interstitial fibrosis had proved to be incorrect. Thereafter, the total number of patients included in the study was 57.

Drug-induced Lung Disease (Eight Patients)

Eight patients were considered to have drug-induced lung disease based on the following criteria: 1) relatively acute onset of respiratory symptoms (cough, dyspnea and/or fever) and diffuse bilateral pulmonary infiltrates during drug therapy, 2) improvement after discontinuation of the drug (in a few cases after commencement of steroids), and 3) only moderate or slight interstitial infiltrations remaining on the chest roentgenograms as a sign of residual fibrosis. Five of the eight patients had

Discussion

Some signs of interstitial lung involvement have been found in 28 and 10 percent of a Finnish RA population using lung function tests or roentgenologic methods of detection, respectively.19 There are about 40,000 RA patients in Finland; hence, thousands of them have interstitial lung disease. It is clinically silent in the majority of patients,8 and during a five-year period only 57 patients were hospitalized because of lung disease, an incidence of one case per 3,500 patient years, and at

Acknowledgment

I thank Dr. Paavo Pääkkö, Department of Pathology, University of Oulu, for re-evaluating the autopsy material; and Dr. Esko Huhti, Department of Medicine, University of Oulu, Oulu and Professor Heikki Isomäki, Rheumatism Foundation Hospital, Heinola for helpful criticisms of the manuscript.

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    This work was supported in part by a grant from the Finnish Anti-Tuberculosis Association, Helsinki, and the Rheumatism Research Foundation, Helsinki, Finland.

    revision accepted June 5.

    Reprint requests: Dr. Hakala, Department of Medicine, Oulu University Central Hospital, SF-90220 Oulu, Finland

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    Copyright © 1988 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.