TAILIEUCHUNG - Pulmonary Manifestations of Rheumatic Disease

Thoracic manifestations of the rheumatic diseases (RDs) are a significant cause of morbidity and mortality worldwide. The five RDs most frequently associated with pleuropulmonary disease are (1) rheumatoid arthritis (RA), (2) systemic lupus erythematosus (SLE), (3) progressive systemic sclerosis (PSS), (4) polymyositis/dermatomyositis (PM/DM), and (5) Sjögren syndrome (SS). The clinical presentation is highly variable, ranging from pleuritic pain alone to slowly progressive breathlessness accompanied by cough. On occasion RD may present acutely with overwhelming respiratory failure as the first pulmonary manifestation. In all of the RDs, the pathology is dominated by either or both inflammation and fibrosis, but the anatomical. | Pulmonary Manifestations of Rheumatic Disease Preface Kristin B. Highland MD MSCR Guest Editor At the Medical University of South Carolina the pulmonary and rheumatology divisions share clinic space and a conference table . As a result our rheumatology fellows are well versed in interpreting pulmonary function testing and our pulmonary fellows routinely inject everyone s knees before their 6-minute walk Kidding aside a close collaboration between these 2 disciplines is paramount in taking care of the complex patient with rheumatic lung disease. lt has been 13 years since Clinics in Chest Medicine devoted an issue to the pulmonary complications of the connective tissue diseases. During this last decade methods used to detect autoantibodies have become increasingly sensitive leaving the physician to wonder if she is dealing with an autoimmune disease confined to the lungs autoimmune lung disease versus a false positive. Bronchoscopy for the diagnosis of alveolitis has fallen in and out of favor but still remains an important research tool and is useful for exclusion of infection and or alveolar hemorrhage. This decade has brought about new insights into the pathogenesis of the rheumatic diseases and their phenotypic expression. It has been an amazing time for the development of medications for the treatment of rheumatoid arthritis and the inflammatory arthropathies. At last there was a positive randomized-placebo-controlled trial in scleroderma a disease that has been notorious for being refractory to all therapy. We now also have more tools in our arsenal to treat the other connective tissue diseases and the vasculitides. Consequently there is a heightened awareness of the potential pulmonary and nonpulmonary toxicity of these medications. There is also a greater concern for the long-term complications of chronic glucocorticoid therapy. New interventional rigid and flexible bronchoscopic techniques have also resulted in advances in the treatment of difficult .

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