Rheumatic Lung Disease

Introduction.

Rheumatic diseases are autoimmune, inflammatory disease conditions that occur when the immune system attacks the healthy cells and tissues of the body. It mainly affects the joints, bones, and muscles, and the progression of the disease can affect internal organs - such as the lungs.

What Causes Rheumatoid Lung Disease?

Studies suggest that the high fatality rate among rheumatic individuals could be because of the breathing difficulties they experience. The exact cause of the deterioration in lung health is not known. However, most studies claim medications (such as Methotrexate) to be a possibility, as they can cause side effects, make individuals vulnerable to infections, or even cause toxicity that may affect the lungs.

Who Is at Risk of Developing Rheumatoid Lung Disease?

Rheumatic diseases may progress and affect the lungs in some individuals. However, one may be at higher risk of the lungs getting affected in the presence of certain factors, such as:

• A habit of smoking.

• Severe rheumatoid disease condition.

• Long-standing rheumatoid diseases.

• Gender - Male.

• Aged individuals.

• Genetic factors.

What Are the Types of Rheumatoid Lung Disease?

Rheumatoid lung diseases include various forms that affect the lung parenchyma, pleura, airways, or vasculature and subsequently affect lung health. Some rheumatoid lung conditions are as follows:

1. Interstitial lung disease (ILD) - This is the most common form of rheumatoid lung disease. Interstitial lung disease causes inflammation and scarring of the lung tissue, and around the lung's air sacs and affects lung health. Interstitial lung disease causes breathing difficulties, chronic dry cough, weakness, and fatigue. Interstitial lung disease causes serious pulmonary complications in individuals with rheumatoid disease. Studies have shown that interstitial lung disease is responsible for mortality and morbidity among rheumatic individuals.

2. Bronchiectasis - Bronchiectasis is a condition where the airway of the lungs widens. Widening of the airways causes mucus build-up which makes the individual more susceptible to infections and inflammations. Bronchiectasis individuals suffer from shortness of breath, weakness, fatigue, and a chronic dry cough.

3. Pleural Effusion - This occurs when excess fluid accumulates in the pleural space (the space between the lung and chest wall). The tissue around the lungs can become inflamed, which can cause chest pain and shortness of breath. Pleural effusion of small areas is usually unnoticed and resolves on its own, however larger pleural effusion needs attention and treatment as it can cause shortness of breath along with pain, and fever in some individuals.

4. Pulmonary Nodules - Pulmonary nodules are rounded abnormal growth found on the lungs that can be benign or malignant. The nodules may range in size and individuals may have single or multiple lung nodules present. The nodules are usually harmless and show no signs or symptoms of lung disease. However, if the nodule ruptures (rarely) it could cause pneumothorax (air leaks into the space between your lung and chest wall).

5. Pulmonary Hypertension - Pulmonary hypertension is a condition when the blood pressure in the blood vessels running from the lungs to the heart is high. Pulmonary hypertension can lead to heart failure.

How to Diagnose Rheumatic Lung Disease?

A medical history of rheumatic disease, a physical examination, and a few tests can confirm the diagnosis of rheumatic lung disease. The tests required are as follows:

• Chest X-ray - To examine lung health and detect the presence of air around the lung tissue, infection, or cancer.

• Computed Tomography (CT) Scan - CT scan of the chest is recommended to check for scarring of the lung tissue.

• Echocardiogram - To check for pulmonary hypertension.

• Biopsy - Biopsy is done to check for the presence of lung malignancies or the nature of lung nodules (if benign or malignant).

• Lung Function Tests - To determine the impairment of the lungs by measuring the lung capacity, the volume of air in the lungs, and how much oxygen passes into the bloodstream.

• Thoracentesis - Thoracentesis is a procedure to check for the presence of fluid or air around the lungs and remove it using a thin needle inserted through the chest wall into the lung space (pleural space).

• Blood Tests for Rheumatoid Arthritis - Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein show the presence of inflammation as in the case of rheumatoid arthritis.

How to Treat Rheumatoid Lung Disease?

The treatment of rheumatoid lung disease depends on the type and severity of the disease. The prime goal of the treatment modality is to reduce inflammation and prevent or slow down the progression of lung damage, as reversing any existing lung damage is not possible. Some of the common treatments for rheumatoid lung disease are as follows:

1. Medications - Non-steroidal anti-inflammatory drugs (Ibuprofen), corticosteroids (Prednisolone), disease-modifying antirheumatic drugs (DMARDs - Methotrexate), and biologicals (a new line of DMARDs- Adalimumab) are some of the medications prescribed to relieve pain and inflammation associated with rheumatoid diseases. Managing rheumatic disease progression with the help of medication can prevent or reduce the risk of lung involvement.Studies have shown that the use of Nintedanib (a kinase inhibitor drug) helped slow the progression of interstitial lung disease by acting on the enzyme responsible for lung tissue scarring.

2. Oxygen Therapy - For individuals with severe breathing difficulties, the extra oxygen is given through nasal cannula or masks. Supplemental oxygen therapy can improve oxygen levels in the blood and body thereby making breathing easier.

3. Pulmonary Rehabilitation - Pulmonary rehabilitation involves exercise training, breathing exercises, and education to improve lung function and quality of life for individuals suffering from debilitating lung conditions.

4. Surgery - In some cases, surgery may be necessary to remove damaged lung tissue or treat complications such as pleural effusion. In severe cases,(for example: interstitial lung disease) lung transplant may also be required to improve the quality of life for the individual.

5. Lifestyle Changes - Quit smoking, maintain a healthy weight, and avoid exposure to environmental irritants (such as air pollution, chemical fumes, aerosol particles, and exposure to hazardous materials such as asbestos and pesticides). This can help manage symptoms and prevent further damage to the lungs.

6. Exercise - Regular exercise does not necessarily improve rheumatic lung conditions but it can improve rheumatic conditions and eventually slow the progression of lung involvement.

Conclusion

The majority of respiratory manifestations occur within the first five years for rheumatoid individuals. Respiratory symptoms may precede the onset of articular symptoms in some. However, they may be masked by poor functional status from joint disease or chronic inflammation. It is important for individuals with rheumatoid lung disease to have regular check-ups to monitor their symptoms, lung function and adjust treatment as needed.