Drug-induced lung disease in rheumatoid

[Guest guest]

Overview of lung disease associated

with rheumatoid arthritis

 

 

 

 

 

 

 

Fiona

R Lake, MD, FRACP

 

http://patients.uptodate.com/topic.asp?file=int_lung/9881

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INTRODUCTION

— Rheumatoid arthritis (RA) is a generally progressive systemic

autoimmune process characterized by chronic symmetrical erosive

synovitis. Nonarticular manifestations of RA include subcutaneous

nodules, vasculitis, pericarditis, mononeuritis multiplex, and

episcleritis [1].

Pulmonary and pleural abnormalities are common in patients with RA, but

may not result in significant symptoms. An overview of lung disease

associated with RA will be presented here. Other aspects of RA,

including specific causes of lung disease seen in patients with RA, are

discussed elsewhere. (See

"Clinical features of rheumatoid arthritis", see

"Interstitial lung disease in rheumatoid arthritis", and see

"Drug-induced lung disease in rheumatoid arthritis").

The differential diagnosis of pleuropulmonary disease in

patients with RA is broad [2-5].

The major causes include:

 

Rheumatoid-associated lung disease (show

table 1)

Drug-related lung disease secondary to drugs used to treat

rheumatoid disease (show

table 2)

Infection secondary to immunosuppression

Coexistent medical conditions (eg, asthma, heart failure)

Overlapping clinical syndromes

 

EPIDEMIOLOGY

— The prevalence of different types of pulmonary disease is difficult

to estimate for a number of reasons. Patient populations have been

heterogeneous among studies; examples include studies of patients with

early versus late stage disease, and community versus hospital versus

autopsy based studies. In addition, there is substantial variability in

the sensitivity of tests used to define disease, ranging from analysis

of pulmonary function to chest radiographs to high resolution computed

tomography. Finally, the subclinical nature of the disease in many

patients has implications for disease surveillance, monitoring of

abnormalities, and consideration of early preventive therapy, which may

further complicate definitive epidemiologic assessment [6,7].

(See

"Interstitial lung disease in rheumatoid arthritis", section on

Epidemiology)

Despite

these limitations, it appears that interstitial lung disease (ILD) and

pleural disease are most common; ILD, obliterative bronchiolitis (OB),

drug reactions, and infections have the greatest impact on patient

outcome. HLA associations have been correlated with the aggressiveness

of joint disease [8],

but associations of HLA or clinical markers of disease with lung

disease have not been recognized. (See

"HLA and other susceptibility genes in rheumatoid arthritis").

INTERSTITIAL

LUNG DISEASE — Interstitial lung disease is the most common

manifestation of rheumatoid lung disease [5].

Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is

frequently similar to idiopathic pulmonary fibrosis (IPF) in terms of

its clinical presentation, pathology, disease spectrum, and

pathogenesis [2,3,9].

However, a wide spectrum of findings may be present on lung biopsy in

patients with RA-ILD; these changes can generally be classified

histologically as a form of idiopathic interstitial pneumonia (IIP) (show

table 1). Typical findings include [10,11]:

 

Usual interstitial pneumonitis (UIP), the pathologic

correlate of IPF, which is most common

Nonspecific interstitial pneumonitis (NSIP)

Lymphocytic interstitial pneumonitis (LIP)

Desquaminative interstitial pneumonitis (DIP)

[Guest guest]

> INTRODUCTION -- Rheumatoid arthritis (RA) is a generally progressive

> systemic autoimmune process ...

 

Drugs aren't necessary in the first place; all one needs is some detoxification

and attention to nutritional deficiencies.

 

I have seen RA and other autoimmune disorders reversed with such a program,

which used glyconutrients to normalize the immune response, cold-processed

whey that stopped the chain reaction of oxidative stress AND workd as an

immunomodulator, and vitamin and mineral support using Body Balance, which

supplied more than 70 minerals, immune response-correcting phytosterols,

healing aloe vera and sea vegetable polysaccharides. Polysaccharides confer

immune system abilities and normalization.

 

The detox was pretty well just diet restriction away from carbs and oxidizing

unsaturated oils, liver flushes, and correcting bowel bacteria that produce

toxin load 24/7 with inulin.

 

Sounds too simple to do anything, but this simple approach works very well.

 

regards,

 

Duncan Crow