Respiratory symptoms and disease characteristics as predictors of pulmonary function abnormalities in patients with rheumatoid arthritis: an observational cohort study

Abstract

Introduction: Lung involvement is a common extra-articular manifestation of rheumatoid arthritis (RA) that confers significant morbidity and mortality. The objective of the present study is to assess which respiratory symptoms and patient and disease characteristics are most highly associated with pulmonary function test (PFT) abnormalities in an RA patient cohort without clinical cardiovascular disease.

Methods: A total of 159 individuals with RA and without clinically evident cardiovascular disease were evaluated. Respiratory symptoms were assessed with the Lung Tissue Research Consortium questionnaire and all patients underwent evaluation with PFTs. Demographic, lifestyle, RA disease and treatment characteristics were collected. Subclinical coronary artery disease was assessed by cardiac computed tomography. Multivariable regression analysis was used to identify pulmonary symptoms and nonpulmonary parameters associated with PFT abnormalities. Areas under the receiver operating characteristic curves (AUC) were calculated to evaluate the discrimination of these variables for identifying patients with PFT abnormalities.

Results: Respiratory symptoms were reported by 42% of the patient population. Although only 6% carried a prior diagnosis of lung disease, PFT abnormalities were identified in 28% of the subjects. Symptoms combined with other patient and RA characteristics (body mass index, current smoking, anti-cyclic citrullinated peptide antibodies, and current prednisone use) performed satisfactorily in predicting the PFT abnormalities of obstruction (AUC=0.91, 95% confidence interval=0.78 to 0.98), restriction (AUC=0.79, 95% confidence interval=0.75 to 0.93) and impaired diffusion (AUC=0.85, 95% confidence interval=0.59 to 0.92). Co-morbid subclinical coronary artery disease did not modify these relationships.

Conclusions: Assessment of respiratory symptoms along with a limited number of clinical parameters may serve as a useful and inexpensive clinical tool for identifying RA patients in need of further pulmonary investigation.

Figure 1

Schematic of screening for a patient with rheumatoid arthritis and without known lung disease. Application of the described algorithm to a model patient demonstrates how the probability of pulmonary function test (PFT) abnormality varies with specific patient features. See Additional file 3 for calculated probabilities based on the presence of different combinations of predictors. CCP, cyclic citrullinated peptide.