ABSTRACT
Rheumatoid arthritis is a chronic inflammatory systemic disease. Pulmonary manifestations are the most common extra-articular involvements and can impact all components of the respiratory system: parenchyma, pleura, vessels and airways, all complications that are briefly described in this article. Interstitial lung disease is the most common of these and is associated with significant morbidity and mortality. Its detection and monitoring are based on spirometry and thoracic imaging. Specific treatments are initiated in order to reduce the risk of disease flare up but may themselves in case of toxicity be associated with respiratory manifestations, either directly or by promoting infectious complications.
La polyarthrite rhumatoïde est une pathologie systémique inflammatoire chronique. Les manifestations pulmonaires représentent l'atteinte extra-articulaire la plus fréquente et peuvent affecter tous les composants du système respiratoire : le parenchyme, la plèvre, les vaisseaux et les voies aériennes, complications décrites brièvement dans cet article. La pneumopathie interstitielle diffuse en est la plus commune et associée à une morbi-mortalité importante. Son dépistage et son suivi reposent sur les épreuves fonctionnelles et l'imagerie thoracique. Des traitements spécifiques sont initiés afin de limiter au mieux l'évolution pulmonaire, mais peuvent eux-mêmes être associés à des manifestations respiratoires, soit directement, soit en favorisant des complications infectieuses.
Subject(s)
Arthritis, Rheumatoid , Lung Diseases, Interstitial , Lung Diseases , Humans , Lung Diseases/etiology , Lung Diseases/complications , Arthritis, Rheumatoid/complications , Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/etiology , Lung Diseases, Interstitial/therapyABSTRACT
BACKGROUND: Neutrophils have been involved in the pathogenesis of chronic obstructive pulmonary disease (COPD). Underlying mechanisms of neutrophil accumulation in the airways of stable and exacerbated COPD patients are poorly understood. The aim of this study was to assess exhaled breath condensate (EBC) neutrophil chemotactic activity, the level of two chemoattractants for neutrophils (GRO-α and LTB4) during the course of an acute exacerbation of COPD (AECOPD). METHODS: 50 ex smoking COPD patients (33 with acute exacerbation and 17 in stable disease) and 20 matched ex smoking healthy controls were compared. EBC was collected by using a commercially available condenser (EcoScreen®). EBC neutrophil chemotactic activity (NCA) was assessed by using Boyden microchambers. Chemotactic index (CI) was used to evaluate cell migration. LTB4 and GROα levels were measured by a specific enzyme immunoassay in EBC. RESULTS: Stable COPD and outpatients with AECOPD, but not hospitalized with AECOPD, had raised EBC NCA compared to healthy subjects (p < 0.05 and p < 0.01 respectively). In outpatients with AECOPD EBC NCA significantly decreased 6 weeks after the exacerbation. Overall EBC NCA was weakly correlated with sputum neutrophil counts (r = 0.26, p < 0.05). CONCLUSIONS: EBC NCA rose during acute exacerbation of COPD in ambulatory patients and decreased at recovery. While LTB4 seems to play a role both in stable and in exacerbated phase of the disease, the role of GRO-α as a chemotactic factor during AECOPD is not clearly established and needs further investigation.
