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Pulmonary involvement in rheumatoid arthritis – Another face of the coin

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ABSTRACT
Rheumatoid arthritis (RA) is a systemic autoimmune disorder that causes progressive, symmetric, erosive destruction of cartilage and bone, which is usually associated with autoantibodies production. It is common that articular signs and symptoms develop long before extraarticular signs, but sometimes lung involvement is the first manifestation of RA and the most aggressive feature of the disease. Respiratory symptoms can precede the articular symptoms in 10–20% of cases. However, they may be masked by the poor functional status from joint disease or chronic inflammation. The pulmonary involvement can be due to the chronic inflammation caused by the disease or it can be secondary to immune-modulating medication. The pulmonary disease due to the disease itself includes: interstitial lung diseases, airways involvement (large and small airways), pleural involvement, rheumatoid pulmonary nodules and vascular pathology. The most used medication in patients with RA, such as metotrexate, leflunomide, TNF alpha blockers, but also other used drugs, may cause pulmonary diseases.

Key words: rheumatoid arthritis, pulmonary involvement, interstitial lung disease, drug toxicity.

INTRODUCTION
Rheumatoid arthritis (RA) is a systemic autoimmune disorder that causes progressive, symmetric, erosive destruction of cartilage and bone, which is usually associated with autoantibodies production. Chronic inflammation causes thickening of the synovium, resulting in swelling and pain in and around the joints. If inflammation continues, it can damage the cartilage, elastic tissue that covers the ends of bones in a joint, as well as the bones themselves. Over time, a loss of cartilage appears, and the joint space between bones can become smaller. Joints become loose, unstable, painful, lose their mobility and deformity can also occur. Joint damage is irreversible, and because it occurs early, early diagnosis and aggressive treatment of RA are recommended. The incidence of RA is about 1% in developed countries, affecting mostly women1. The lung is a common site of extra-articular disease and is an important contributor to mortality and morbidity2.

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