Gazi Journal of Health Sciences

Abstract

Although rheumatoid arthritis (RA) is a disease of unknown cause and affects the joints, it has many extra-articular findings. The pulmonary system is frequently affected in RA, resulting in increased morbidity and mortality. Although numerous tissues, including the parenchyma, pleura, veins and airway, are damaged, interstitial lung disease is the most severe lung involvement (ILD). Patients with clinical manifestations of RA-associated ILD constitute approximately 10% of those with RA, while the prevalence of non-clinical ILD is approximately 60%. It is thought that RA-associated ILD includes an interaction between smoking history, advanced age, male gender, and genetic predispositions such as the HLA-DRB1 gene. RA-associated ILD is histopathologically and radiologically seen as usual interstitial pneumonia, often followed by nonspecific interstitial pneumonia. Solomon et al. found that patients followed with the pattern of usual interstitial pneumonia had a shorter survival time than patients with a pattern of nonspecific interstitial pneumonia. A recent retrospective study that followed patients with RA and RA-associated ILD from 2005 to 2018 found that while overall RA-related mortality rates decreased, mortality rates in RA-related ILD remained stable. Improved treatments for RA lead to improved overall outcomes, but have limited efficacy in the RA-associated ILD group. Inspection, dyspnea, cough, chest pain, pulmonary function tests, respiratory muscle strength and endurance, exercise capacity, peripheral muscle strength, physical activity, and quality of life assessments are all carried out in physiotherapy for RA-related pulmonary involvement. Dyspnea during exertion is a very common complaint in ILD. Dyspnea may develop during exertion due to disease progression, drug toxicity, and respiratory/cardiovascular morbidities in RA. In addition to restrictive pulmonary dysfunction, patients also have obstructive pulmonary dysfunction. Patients with RA have decreased respiratory muscle strength, lung volumes, oxygen consumption, and 6MWT distance, which causes cardiopulmonary deconditioning. Patients' risk of hospitalization and mortality from cardiovascular reasons is increased if their 6-minute walk test (6MWT) distance is less than 345 meters. In RA patients, the decrease in oxygen consumption level also raises their mortality risk and cardiovascular disease risk. Recently, tests that evaluate functionality and endurance such as the Glittre activities of daily living test and the unsupported upper-limb excersise test have been used in patients with RA. Patients with RA may have rheumatoid cachexia, which is characterized by decreased muscle mass and increased fat mass. Peripheral muscles are affected in the early stages of the disease in patients with RA, and muscle pathology and weakness persist even in clinical remission. Decreased physical activity in patients with RA increases the rate of locomotive syndrome and frailty.