Pulmonary impairment in rheumatoid arthritis.

295 Rev Bras Reumatol 2011;51(4):295-8 Impairment of the respiratory system in rheumatoid arthritis (RA) is an important cause of morbidity and mortality.1 The manifestations can vary and include interstitial pulmonary infi ltrates, pleural impairment, single or multiple pulmonary nodules, disorders of the central and peripheral airways, vascular bed diseases, drug-induced pulmonary toxicity, and secondary infections.1-3 Among all those possibilities, interstitial pulmonary infi ltrates gain importance due to their greater prevalence and possible progression to end-stage pulmonary fi brosis with respiratory failure. Usually, pulmonary impairment in RA occurs in patients with well-established articular disease.1-3 However, pulmonary infi ltrates can be the fi rst manifestation of the disease in up to 20% of the cases.1 Much of what is known about pulmonary impairment in RA has been identifi ed in recent years, mainly after the appearance of more sophisticated radiological techniques, such as chest high-resolution computed tomography obtained with advanced technology devices. Studies using that technique have shown pulmonary infi ltrates in 20% to 63% of the patients studied. In addition, such fi ndings can be often seen in asymptomatic patients with respiratory disorders, who have been recently diagnosed with rheumatic disease.4 In such situation, ground glass opacities and subpleural septal thickening predominate, usually of limited extent. In the present number of the Revista Brasileira de Reumatologia, Skare et al.5 studied the presence of tomographic changes in a sample of 71 patients with RA, followed up in specialized clinics and outpatient clinics of the state of Paraná. The prevalence of tomographic changes was 55%, with predominance of the reticular pattern, although the presence of cough and dyspnea was equally low, both in the group with changes and in that without them. In addition, a signifi cant association of the presence of nodular and reticular lesions with the longer duration of disease has also been reported. Such results are in accordance with data previously published in the international literature, and indicate that the radiological detection of pulmonary impairment in RA is an increasingly common reality in the daily clinical practice also in Brazil. The lack of a signifi cant association of the presence of pulmonary Pulmonary impairment in rheumatoid arthritis