Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Respiratory Symptoms and Disease Characteristics as Predictors of Pulmonary Function Abnormalities (PFT) in Patients with Rheumatoid Arthritis (RA)
Pappas, Dimitrios A., Giles, Jon T., Connors, Geoffrey, Lechtzin, Noah, Bathon, Joan M., Danoff, Sonye K.
Timely recognition of the pulmonary manifestations of RA is critical given that respiratory involvement is identified as the second leading cause of mortality in patients with RA. We attempted to identify which respiratory symptoms, patient and disease characteristics are most highly predictive of PFT abnormalities in an RA patient cohort.
A total of 159 individuals with RA were evaluated. Respiratory symptoms were assessed with the Lung Tissue Research Consortium (LTRC) questionnaire and all patients underwent evaluation with PFTs. Demographic, lifestyle, RA disease and treatment characteristics were collected. Multivariable regression analysis was used to identify pulmonary symptoms and non-pulmonary parameters predictive of PFT abnormalities. Receiver operator characteristic (ROC) curves were constructed to examine the ability of our models to predict PFT abnormalities.
Of the 159 patients, 45 (28%) demonstrated at least one predefined PFT abnormality. Restrictive lung disease was observed in 12 (7.6%), obstructive lung disease in 18 (11.3%) and isolated impaired diffusing capacity in 31 (19.8%). Only seventeen patients (37.8%) of the 45 patients with abnormal PFTs reported a prior diagnosis of emphysema, asthma or rheumatoid lung disease. Among RA characteristics, seropositivity for RF (p=0.011) and anti-CCP (p=0.003), and current use of glucocorticoids (p=0.018) were significantly higher in patients with PFT abnormalities. Pulmonary symptoms were reported in 78 patients (42%). For any PFT abnormality the predictors retained in the final multivariable model included two pulmonary symptoms (chronic phlegm and breathlessness with walking 100 yards), and four other characteristics (BMI, current smoking, seropositivity for anti-CCP antibodies, and current prednisone use). AUC=0.773 (95% CI 0.679 0.857)
For restriction, one symptom (breathlessness with level walking) and two patient characteristics (BMI and current prednisone use) were retained in the final prediction equation AUC=0.786 (95% CI 0.585 0.918). For obstruction, 8 predictors were retained in the final model, including one symptom (chronic cough), and six other characteristics (gender, exercise, BMI, current smoking, RF seropositivity, and current prednisone use). AUC=0.905 (0.784 0.978).
For isolated impaired diffusion, six predictors were retained in the final model, including one symptom (chronic phlegm), and four other characteristics (age, BMI, current smoking, and current prednisone use). AUC= 0.852 (95% CI 0.749 0.934).
Assessment of respiratory symptoms along with a limited number of clinical parameters may serve as a useful and inexpensive clinical tool for identifying RA patients in need of further pulmonary investigation.
To cite this abstract, please use the following information:
Pappas, Dimitrios A., Giles, Jon T., Connors, Geoffrey, Lechtzin, Noah, Bathon, Joan M., Danoff, Sonye K.; Respiratory Symptoms and Disease Characteristics as Predictors of Pulmonary Function Abnormalities (PFT) in Patients with Rheumatoid Arthritis (RA) [abstract]. Arthritis Rheum 2009;60 Suppl 10 :956