CHEST Guidelines-Evidence-of-Airways-Disease-as-a-Common-and-Undera

Evidence-of-Airways-Disease-as-a-Common-and-Undera

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The editorial discusses recent findings that airways diseases are a common yet underrecognized manifestation of rheumatoid arthritis (RA). According to the mucosal origins hypothesis, RA may start with inflammation in the airways, triggering autoantibodies years before the disease becomes clinically apparent. Despite advances in RA treatments, patients' respiratory mortality remains high. <br /><br />A study by Matson et al., published in CHEST, examined airways abnormalities in RA patients using pulmonary function tests (PFTs), high-resolution CT (HRCT) scans, and quantitative CT (QCT) analysis, excluding those with interstitial lung disease but including those with asthma, COPD, and bronchiectasis. Their findings showed that 20.7% of the RA cohort exhibited an obstructive pattern on PFTs, with this rate increasing to 61% when assessing airways abnormalities through HRCT scans. Airways diseases were often associated with factors such as older age, smoking history, and elevated rheumatoid factors. Moreover, QCT analysis linked wall thickening and emphysema percentages with RA disease duration and activity.<br /><br />The editorial highlights the significant prevalence of airways diseases like preclinical emphysema among RA patients, including those who have never smoked and without apparent respiratory symptoms. Furthermore, the bidirectional relationship between RA and airways diseases like COPD is emphasized, with evidence suggesting that RA raises the risk of developing these respiratory conditions and vice versa.<br /><br />Challenges remain, such as the limited application of existing QCT protocols and the absence of a healthy comparison group in the study. However, the study underscores the utility of QCT analysis for detecting airways abnormalities in the RA patient population. The editorial calls for further research to determine the impact of these findings on the long-term outcomes for RA patients, suggesting that improved detection of airways diseases could lead to better management strategies.

Keywords

rheumatoid arthritis

airways diseases

mucosal origins hypothesis

pulmonary function tests

high-resolution CT scans

quantitative CT analysis

respiratory mortality

preclinical emphysema

COPD

autoantibodies