The Utility of Immunological Markers and Pulmonary Function Test in the Early Diagnosis of Pulmonary Involvement in the Patients with Rheumatoid Arthritis

Lee, Dong Suk; Lee, Chang Beom; Koh, Hee Kwan; Moon, Doo Seop; Lee, Jae Young; Lee, Kyung Sang; Yang, Suck Chul; Yoon, Ho Joo; Bae, Sang Cheol; Shin, Dong Ho; Kim, Seong Yoon; Park, Sung Soo; Lee, Jung Hee

Abstract

BACKGROUND
It is reported that frequency of pulmonary involvement in the patients with rheumatoid arthritis reaches 10 to 50% and pulmonary involvement is a principal cause of death. As immunology and radiology has developed, interest for the early diagnosis of pulmonary involvement is increasing. METHOD: Among the patients at Hanyang University Hospital from March, 1990 to July, 1995, we compared the 29 patients having pulmonary involvement with the 18 patients controls in clinical and chest high resolution computed tomography(HRCT) findings by immunological markers and findings of pulmonary function test. We sought useful markers for early diagnosis of pulmonary involvement with noninvasive investigations.
RESULTS
The ratio of males to females was 14: 15 in the group of pulmonary involvement, and all of the 18 patients were females in the control group. Smoking history was 31%(9/29) in the former group and none in the latter group. Rheumatoid factor(RF) was positive in 96.5%(28/29) of the pulmonary involvement group and in 100%(18/18) of the control group(p=0.12). Antiperinuclear factor(APF) showed a significant difference: 86.9%(20/23, average value: 2.0) was positive in the pulmonary involvement group and 50%(8/16, average value: 1.1) in the control group(p=0.04). Antinuclear antibody(ANA) was positive in 60.7%(17/28) of the pulmonary involvement group and in 72.2%(13/18) of the control group(p=0.33). Cryoglobulin, also showed a significant difference: 72%(18/25) in the pulmonary involvement group was positive and 56.2% (9/16) in the control group was positive(p=0.02). Bony erosion was positive in 61.5%(16/26) of the pulmonary involvement group and in 77.7%(14/18) of the control group(p=0.8). On the pulmonary function test, the average value of alveolar volume corrected diffusion capacity and residual volume in the pulmonary involvement group and in the control group were 1.07mmol/min/KPa(predicted value: 64.2%), 1.32L(predicted value: 70%)and 1.44mmol/min/KPa, 3.75L(predicted value: 86.6%), respectively(p=0.003, p=0.004), showing a significant difference.
CONCLUSION
APF or cryoglobulin on the serological test, the measurement of residual volume and alveolar volume corrected diffusion capacity may be used as effective markers in the diagnosis of pulmonary involvement of the patients with rheumatoid arthritis.