Relative Factors And Clinical Analysis Of Lung Injury In Rheumatoid Arthritis

Objective To investigate the relative factors and the types of lung injury in rheumatoid arthritis.Method Retrospective analysis was conducted on samples from patients who presented with rheumatoid arthritis from 5.24.2012 to 11.10.2016 in Fujian Provincial hospital.The clinical and laboratory data of these patients was collected and analyzed statistically,including the onset age,sex,course of disease,smoking history,the number of swollen joint and painful joint,morning stiffness,fibrinogen,D-dimers,rheumatoid factor,anti-cyclic citrullinated peptide antibodies,C-reactive protein,erythrocyte sedimentation rate,computed tomography imaging,ultrasonic cardiogram(pulmonary arterial pressure)and precious anti-arthritic treatment(including disease-modifying anti-rheumatic drugs,glucocorticoid and biologics).All the patients were divided into two groups(RA-lung injury group and pure-RA group)based on computed tomography imaging and pulmonary arterial pressure.Logistic regression analysis for Single and multiple factor was done for rheumatoid arthritis risk factors.Meanwhile all the types of the lung injury were categorized to identify the main types.Results A total of 223 patients with rheumatoid arthritis were enrolled in the study,including 79 patients in RA-lung injury group and 144 patients in pure-RA group.The statistic results of onset age(61.63±12.33 VS 55.24±15.02,P=0.001),smoking history(19.0% VS 4.2%,P<0.001)and utilization of glucocorticoid(60.8% VS 45.8%,P=0.033)of RA-lung injury group were significantly higher than pure-RA group,while the results of morning stiffness(50.6% VS 72.2%,P=0.001)was significantly lower than pure-RA group by t-test or Chi-Square test.And there were no statistical differences in sex,course of disease,the number of swollen joint and painful joint,fibrinogen,D-dimers,C-reactive protein,erythrocyte sedimentation rate,rheumatoid factor,anti-cyclic citrullinated peptide antibodies,treatment of disease-modifying anti-rheumatic drugs and biologics between the two groups(P>0.05).Single-factor logistic regression analyses showed that the onset age,smoking history,utilization of glucocorticoid and morning stiffness were associated with lung injury caused by rheumatoid arthritis(P<0.05).And Multivariate Logistic regression analysis showed that the onset age(OR=1.035,95%CI:1.011 ~ 1.059,P=0.004)and smoking history(OR=5.606,95%CI:1.993~15.766,P=0.001)were independent factors influencing the lung injury,while morning stiffness(OR=0.357,95%CI:0.194~0.656,P=0.001)was the protective factors.Among the 79 patients with lung injury,diffuse pulmonary interstitial disease and pulmonary nodule had the highest incidence(32/79,40.5%)and24.1% patients appeared two or more types of lung injury.Conclusion Onset age and smoking are the independent factors of lung injury in patients with rheumatoid arthritis,while morning stiffness was the protective factor.Among the RA patients with lung injury,diffuse pulmonary interstitial disease and pulmonary nodule are the main presentation,and More than a fifth of patients with RA could appear two or more types of lung injury.