Abstract / Summary
Background: Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease that, beyond its classical articular manifestations, frequently involves the lungs.Pulmonary complications, including interstitial lung disease (ILD), pleural disease, airway disease, and pulmonary vascular involvement, are important extraarticular manifestations that contribute substantially to disease morbidity.Many affected patients, however, remain clinically asymptomatic despite radiological or functional abnormalities.Objectives: The primary objective was to characterize the clinical, functional, and radiological pulmonary findings among patients with RA presenting with respiratory symptoms.The secondary objective was to assess the association of pulmonary function test (PFT) and high-resolution computed tomography (HRCT) abnormalities with disease duration and six-minute walk test (6MWT) distance.Methods: This cross-sectional observational study was conducted in the Department of General Medicine at a tertiary care, research, and teaching institute over two years (August 2024 to August 2026).Sixty-five consecutive patients aged >18 years with RA diagnosed according to the 2010 American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) classification criteria and presenting with respiratory symptoms were enrolled by convenience sampling after excluding patients with pre-existing pulmonary disease or a connective tissue disorder other than RA.All patients underwent hematological and serological investigations, a 6MWT, spirometry, chest radiography, and HRCT of the chest.Disease activity was assessed using the Disease Activity Score-28 (DAS-28).Unadjusted associations were assessed using the chi-square test, with p < 0.05 considered statistically significant.Results: Females constituted 72.3% (47/65) of the cohort, and the 41-60-year age group accounted for more than half of the participants (35/65, 53.8%).The mean duration of RA at presentation was 7.1 ± 3.79 years.Chronic cough (43/65, 66.2%) and exertional dyspnea (30/65, 46.1%) were the most common respiratory symptoms, although 46% of patients (30/65) had no abnormal findings on chest auscultation.A restrictive pattern was the most common PFT abnormality (33/65, 50.8%), while a usual interstitial pneumonia (UIP) pattern was the most common abnormal HRCT finding (14/65, 21.5%).Longer disease duration was significantly associated with abnormal PFT findings (χ² = 7.98, df = 3, p = 0.047) and abnormal HRCT findings (χ² = 9.89, df = 3, p = 0.02).Shorter 6MWT distance was significantly associated with abnormal PFT findings (χ² = 20.43,df = 2, p < 0.001) and abnormal HRCT findings (χ² = 10.95,df = 2, p = 0.004).Conclusion: In this single-center sample of patients with RA presenting with respiratory symptoms, PFT and HRCT abnormalities were common, and longer disease duration and shorter 6MWT distance were associated with abnormal PFT and HRCT findings.These unadjusted cross-sectional associations do not establish causation or predictive value, and the findings cannot be used to estimate the prevalence of pulmonary involvement among all patients with RA.Prospective studies with adjustment for potential confounders are needed.