Respiratory system involvement in rheumatic diseases: literature analysis and original data

The article presents the data of current publications on the problem of respiratory lesions in immune-mediated inflammatory rheumatic diseases and the results of our own studies on the frequency and spectrum of bronchopulmonary pathology in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), systemic connective tissue diseases, and ANCA vasculitis. Respiratory system lesions are detected in 24.5–70.2 % of patients with inflammatory RD according to different authors. Interstitial lung diseases, pulmonary fibrosis, and bronchial obstruction prevail in the structure of respiratory disorders. Polymorphism of pulmonary manifestations of RD includes pulmonary hypertension, which is recorded in more than a third of patients with systemic connective tissue diseases. As our own clinical data showed, respiratory lesions occurred in 33 people (27.5 %) out of 120 patients with immune-mediated inflammatory RD. The leading form of damage was interstitial pneumonia and interstitial pulmonary fibrosis. Among the patients with determined lung involvement were individuals with RA, SSc, ANCA vasculitis, AS and Sjogren's disease. The article presents a clinical case of the interstitial pneumonia in a patient with RA. The contribution of uncontrolled rheumatoid inflammation and disease-modifying therapy to the manifestation of pulmonary involvement is discussed. The positive effect of IL-6 inhibitor in abolishing RA activity and pulmonary lesion is shown.