scholarly journals Pulmonary involvement in rheumatoid arthritis: evaluation by radiography and spirometry

2015 ◽  
Vol 41 (4) ◽  
pp. 331-342 ◽  
Author(s):  
Alexandre Melo Kawassaki ◽  
Daniel Antunes Silva Pereira ◽  
Fernando Uliana Kay ◽  
Ieda Maria Magalhães Laurindo ◽  
Carlos Roberto Ribeiro Carvalho ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Smoking Status ◽  
Pulmonary Involvement ◽  
Diagnostic Methods ◽  
Test Results ◽  
Cross Sectional ◽  
X Ray ◽  
Significant Difference ◽  
History Of ◽  
Chest X Ray

AbstractObjective: To determine whether simple diagnostic methods can yield relevant disease information in patients with rheumatoid arthritis (RA).Methods: Patients with RA were randomly selected for inclusion in a cross-sectional study involving clinical evaluation of pulmonary function, including pulse oximetry (determination of SpO2, at rest), chest X-ray, and spirometry.Results: A total of 246 RA patients underwent complete assessments. Half of the patients in our sample reported a history of smoking. Spirometry was abnormal in 30% of the patients; the chest X-ray was abnormal in 45%; and the SpO2 was abnormal in 13%. Normal chest X-ray, spirometry, and SpO2 were observed simultaneously in only 41% of the RA patients. A history of smoking was associated with abnormal spirometry findings, including evidence of obstructive or restrictive lung disease, and with abnormal chest X-ray findings, as well as with an interstitial pattern on the chest X-ray. Comparing the patients in whom all test results were normal (n = 101) with those in whom abnormal test results were obtained (n = 145), we found a statistically significant difference between the two groups, in terms of age and smoking status. Notably, there were signs of airway disease in nearly half of the patients with minimal or no history of tobacco smoke exposure.Conclusions: Pulmonary involvement in RA can be identified through the use of a combination of diagnostic methods that are simple, safe, and inexpensive. Our results lead us to suggest that RA patients with signs of lung involvement should be screened for lung abnormalities, even if presenting with no respiratory symptoms.

scholarly journals A study on diagnostic efficacy of pulmonary imaging tool in patients with rheumatoid arthritis

2019 ◽  
Vol 7 (4) ◽  
pp. 1233
Author(s):  
Kripasindhu Gantait ◽  
Ishita Gantait ◽  
Jamirul Islam ◽  
Tuhinsubhra Sarkar
Keyword(s):  
Rheumatoid Arthritis ◽  
Pulmonary Involvement ◽  
Health Concern ◽  
P Value ◽  
Chi Square ◽  
Diagnostic Efficacy ◽  
Cross Sectional ◽  
X Ray ◽  
Imaging Tool ◽  
Chest X Ray

Background: Pulmonary complication in Rheumatoid arthritis is major health concern in the field of rheumatology. So this study is to find out the sensitive imaging tool for detecting different types of pulmonary changes seen in RA.Methods: This is a comparative, analytical, cross sectional, Institution- based, single centre study. We included all adult willing patients of Rheumatoid arthritis (age >18) and selected them based on 2010 ACR/EULAR criteria. Severity was assessed by number of joints involve in both upper and lower limb, along with ESR, CRP, Anti CCP level. Chest x ray, PFT and HRCT thorax were done in all RA patients.Results: Out of 50 RA patients, pulmonary involvement was observed in 25 patients identified by Spirometry, CXR, HRCT. Pulmonary involvement is more common in age group <40 years. Most common form of pulmonary involvement is ILD followed by obstructive lung disease like chronic bronchitis, bronchiectasis etc. HRCT is the most common tool for detection of Pulmonary involvement in rheumatoid arthritis. HRCT abnormality, most are Restrictive on spirometry (FEV1/FVC) <80% of predicted value. And this relation is statistically significant as P value is 0.001 (<0.05) by Chi-Square test. Patients having more the disease duration, more the pulmonary involvement. This association is statically significant as p value is 0.001 (<0.05).Conclusions: High resolution CT thorax is more sensitive modality for detection of pulmonary pathology in rheumatoid arthritis. Because of its high cost, availability of this imaging technique is beyond the lower socio-economic group where chest x ray may be useful.

scholarly journals AB0170 RHEUMATOID ARTHRITIS ASSOCIATED LUNG DISEASE: EXPERIENCE IN A BIOLOGICAL THERAPY UNIT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1111.2-1112
Author(s):  
L. Vega ◽  
I. Calvo ◽  
O. Ibarguengoitia ◽  
D. Montero ◽  
C. García ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Lung Disease ◽  
Interstitial Pneumonia ◽  
Gold Standard ◽  
Biological Therapy ◽  
Pulmonary Involvement ◽  
Disease Diagnosis ◽  
Classification Criteria ◽  
X Ray ◽  
Chest X Ray

Background:Rheumatoid arthritis (RA) associated lung disease is a relatively frequent extra articular disease manifestation, with a prevalence between 5% and 30%. The rather wide range of estimated prevalence is a result of differences in study designs and studied populations, as well as lacking diagnostic and classification criteria for lung disease in patients with RA.Objectives:To evaluate the prevalence of RA associated lung disease in patients with biological therapy (BT), as well as its severity, treatment changes and possible associated factors.Methods:Review of clinical records of 257 patients with RA treated with BT (TNFi, non-TNFi) between January 2015 to December 2020 in a single center. Patients with preexisting lung disease for other causes (asthma, smoking) have been excluded. RA diagnosis was performed according to ACR 2010 classification criteria. Epidemiological variables, clinical characteristics, type of pulmonary involvement, evolution, type of BT, changes in treatment and concomitant treatment were collected. For the analysis frequencies and percentages are used in qualitative variables, and mean ± SD in the quantitative ones. Statistical analysis was performed with IBM SPSS v 23.Results:We registered 21 patients (85.7% women) mean aged 70.3±11.9 years. 52.4% were never smokers. RF was positive in 100% and 20 patients were anti-CCP positive. Erosive disease was present in 13 (61.9%) patients.At the time of lung disease diagnosis, 15 patients (66.7%) were receiving TNFi (Etanercept 7, Adalimumab 6, Infliximab 1, Golimumab 1), 2 were with non-TNFi (Rituximab) and 4 had never received BT previously. Symptoms (cough and/or dyspnea) were reported in 10 (47.6%) patients. The median time of treatment with BT until lung disease diagnosis was 33 [15.5-95.5] months. Conventional synthetic DMARDs (csDMARDs) were used in 85.7% of cases (methotrexate 72.2%, leflunomide 22.2%, other 5.6%). The inflammatory activity was mild (DAS28: 3.22±1.6). The median time until lung disease diagnosis was 104 [56.2-156] months.After the lung disease diagnosis, BT was only modified in 1 patient. In the 4 patients who had not previously received BT, non-TNFi was started (Rituximab 2, Abatacept 1, Tocilizumab 1). csDMARD was discontinued in 1 patient.Interstitial lung disease (ILD) was the most frequent pulmonary involvement (16 patients, 76.2%): 8 usual interstitial pneumonia (UIP), 6 non-specific interstitial pneumonia (NSIP), 1 organising pneumonia (OP) and 1 lymphocytic interstitial pneumonia (LIP). Other pulmonary manifestations observed in our patients were: nodular lung disease (2 patients) and small airways disease (bronchiectasis 2, obliterative bronchiolitis 1). Chest x-ray was normal in almost half of the patients (42.9%). Gold standard image diagnostic technique was high resolution CT.In respiratory function tests (PFTs) at diagnosis, only 4 patients (19%) had a FVC<80% and 4 (19%) a DLCO<60%. In the following 2 years, in 2 patients the FVC worsened > 10% and in 5 there was a worsening of the DLCO > 15%. In 3 (14.3%) patients PFTs were never performed and in 7 (43.7%) were not repeated after the diagnosis.We haven´t found association between different types of pulmonary involvement and the variables analysed.Conclusion:In our series, prevalence of RA associated lung disease is similar to that described in the literature. Lung involvement is asymptomatic and chest X-ray is normal in most RA patients. High resolution CT is the gold standard for diagnosis.ILD was the most frequent pulmonary involvement. Although in most patients the diagnosis of lung disease did not imply a BT change, it had an influence on the type of BT chosen for those who started treatment. Maintenance of csDMARD was not associated with a worsening of lung disease.Screening and treatment protocols for lung disease in patients with RA in clinical practice are needed.Disclosure of Interests:None declared

scholarly journals Severe Hemolytic Anemia Associated with Mild Pneumonia Caused byMycoplasma pneumonia

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Zafer Kurugol ◽  
Serife Sebnem Onen ◽  
Guldane Koturoglu
Keyword(s):  
Hemolytic Anemia ◽  
Hematological Malignancies ◽  
Pulmonary Involvement ◽  
Atypical Pneumonia ◽  
X Ray ◽  
Breath Sounds ◽  
Chest Examination ◽  
History Of ◽  
Chest X Ray ◽  
Red Cell Transfusion

We report a case ofM. pneumoniaeinfection presenting with severe hemolytic anemia in a 4-year-old girl, with a ten-day history of paleness, weakness, and nonproductive cough. She was very pale and tachycardic. However, she was not tachypneic. Chest examination showed normal breath sounds. No rhoncus or whistling was heard. As the erythrocyte sedimentation rate was excessively elevated, the differential diagnosis primarily comprised hematological malignancies. Direct Coombs' test was positive. Diagnosis ofM. pneumoniaeinfection was confirmed by elevated levels ofM. pneumoniaeIgG and IgM antibodies and a chest X-ray suggestive of atypical pneumonia. The patient was treated with clarithromycin and packed red cell transfusion and showed a favorable recovery within ten days after admission. In conclusion, this case demonstrates that severe hemolytic anemia caused byM. pneumoniaeis not always associated with severe pulmonary involvement, even when the respiratory infection is very mild,M. pneumoniaemay be the cause of severe anemia.

scholarly journals Correlation between Chest X-Ray Severity in COVID-19 and Age in Mexican-Mestizo Patients: An Observational Cross-Sectional Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Arturo Albrandt-Salmeron ◽  
Ruby Espejo-Fonseca ◽  
Ernesto Roldan-Valadez
Keyword(s):  
Age Groups ◽  
Rank Correlation ◽  
Cross Sectional Study ◽  
European Population ◽  
Cross Sectional ◽  
Mexican Mestizo ◽  
X Ray ◽  
Significant Difference ◽  
Chest X Ray ◽  
Males And Females

Introduction. Chest X-ray (CXR) is used for the initial triage of patients with suspected COVID-19. Studies of CXR scoring in the European population found a higher score in males than in females and significantly correlated with age. Because there have not been studies in the Mexican-mestizo community, we aimed to compare the differences in CXR scores between males and females and their correlation with age after controlling comorbidities like diabetes and hypertension. Materials and Methods. A retrospective study of 1000 CXR of Mexican-mestizo patients with SARS-CoV-2 infection, confirmed by RT-PCR. Significant differences between age, age groups, symptoms, comorbidities, and CXR scores between males and females used the Mann–Whitney U , Chi-square tests ( χ 2 ), and Kruskal–Wallis tests. The relationship between the total CXR score and age was measured with the Spearman rank correlation coefficient (Rs); partial correlation analysis controlled the effect of symptoms, risk factors, and comorbidities. Results. The total CXR score did not show a difference between males and females grouped by age. There was a positive, low correlation between the total CXR score and age in males, Rs = 0.260 , p < 0.001 ( N = 616 ), and in females, Rs = 0.170 , p = 0.001 ( N = 384 ). Age only explained a <9% variance of CXR severity. Rs decreased its magnitude (from Rs = 0.152 to Rs = 0.046 ) and lost its significance (change in p value from p < 0.001 to p = 0.145 ) after controlling the effect of hypertension. Conclusions. There is no significant difference in CXR score between males and females in the Mexican-mestizo population grouped by age. Hypertension cancels the significance of CXR severity with age pointing to its role in the pathophysiology of COVID-19. Further research using stratified groups by age and gender in other populations needs to be published.

scholarly journals Lung Ultrasound in Patients With Dyspnea From Infective Lung Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Pierluigi Bracciale ◽  
Salvatore Bellanova ◽  
Cristiana Cipriani
Keyword(s):  
Pleural Effusion ◽  
Lung Disease ◽  
Lung Diseases ◽  
Lung Ultrasound ◽  
Cross Sectional Study ◽  
Chest Ct ◽  
Cross Sectional ◽  
X Ray ◽  
Significant Difference ◽  
Chest X Ray

Infective lung disease is a spectrum of pulmonary disorders with high prevalence in clinical practice. In the last decade, many studies focused on the clinical usefulness of lung ultrasound (LUS) in the management of patients presenting with dyspnea from infective lung disease. We report data on the methodological and standardized use of bedside LUS in the differential diagnosis of patients with acute dyspnea from infective lung diseases. We performed a cross-sectional study in 439 patients (160 women and 279 men, mean age 64.2 ± 11.5 years, age range 23–91 years) with infective lung diseases. A bedside LUS with a convex probe and chest X-ray were performed in all subjects. Chest CT was performed in a subgroup of patients, as clinically needed. We observed a statistically significant difference in the percentage of pleural effusion and pulmonary consolidation assessed by LUS, compared to X-ray (52.7 vs. 20%, respectively, p &lt; 0.05; 93.6 vs. 48.2%, p &lt; 0.001). The majority of the consolidations detected by LUS were mixed, hypo- and hyperechoic, lesions, with air bronchogram in 40% of cases. All findings assessed by LUS were confirmed by chest CT, when performed. We describe the actual role of LUS in the assessment of patients with infective lung disease. It has higher sensitivity compared to chest X-ray in the detection of pleural effusion. Consolidations from infective lung disease have mostly mixed echogenicity by LUS.

Lingual Dystonia Treated with Botulinum Toxin - A Case Report

1970 ◽  
Vol 24 (2) ◽  
pp. 75-78
Author(s):  
MA Hayee ◽  
QD Mohammad ◽  
H Rahman ◽  
M Hakim ◽  
SM Kibria
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin A ◽  
Botulinum Toxin Type A ◽  
Botulinum Toxin Type ◽  
X Ray ◽  
Medical College ◽  
Lingual Dystonia ◽  
History Of ◽  
Chest X Ray

A 42-year-old female presented in Neurology Department of Sir Salimullah Medical College with gradually worsening difficulty in talking and eating for the last four months. Examination revealed dystonic tongue, macerated lips due to continuous drooling of saliva and aspirated lungs. She had no history of taking antiparkinsonian, neuroleptics or any other drugs causing dystonia. Chest X-ray revealed aspiration pneumonia corrected later by antibiotics. She was treated with botulinum toxin type-A. Twenty units of toxin was injected in six sites of the tongue. The dystonic tongue became normal by 24 hours. Subsequent 16 weeks follow up showed very good result and the patient now can talk and eat normally. (J Bangladesh Coll Phys Surg 2006; 24: 75-78)

scholarly journals Prevalence of latent tuberculosis infection and feasibility of TB preventive therapy among Thai prisoners: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sivaporn Gatechompol ◽  
Weerakit Harnpariphan ◽  
Ruamthip Supanan ◽  
Gompol Suwanpimolkul ◽  
Jiratchaya Sophonphan ◽  
...  
Keyword(s):  
Latent Tuberculosis ◽  
Cross Sectional Study ◽  
Preventive Therapy ◽  
Sectional Study ◽  
Cross Sectional ◽  
Ltbi Prevalence ◽  
History Of ◽  
Chest X Ray ◽  
Latent Tb ◽  
Latent Tb Infection

Abstract Background Prisons are considered as major reservoirs for tuberculosis. Preventive therapy for latent TB infection (LTBI) is an adjunctive strategy to control TB. However, LTBI data in Thai prisoners is limited. This study assessed the prevalence of LTBI and feasibility of isoniazid preventive therapy (IPT). Methods A cross-sectional study was conducted among prisoners in Klong Prem Central Prison, Bangkok. Participants were screened for active TB by questionnaire and chest X-ray. LTBI was evaluated by Tuberculin skin test (TST) and QuantiFERON-TB Gold Plus (QFTP) among subgroup. Participants with positive TST or QFTP were considered to have LTBI. Participants with LTBI were offered IPT. Results From August 2018–November 2019, 1002 participants were analyzed. All participants were male with a median age of 38 (IQR 32–50) years. LTBI identified by either TST/QFTP was present in 466 (46.5%) participants. TST was positive in 359 (36%) participants. In the subgroup of 294 participants who had both TST and QFTP results, 181/294 (61.6%) tested positive by QFTP. Agreement between TST and QFTP was 55.1% (Kappa = 0.17). The risk factors associated with LTBI were previous incarceration (aOR 1.53, 95%CI, 1.16–2.01, p = 0.002), history of prior active TB (aOR 3.02, 95%CI, 1.74–5.24, p < 0.001) and duration of incarceration ≥10 years (aOR 1.86, 95%CI, 1.24–2.79, p = 0.003). Majority of LTBI participants (82%) agreed to take IPT. Three hundred and 56 (93%) participants completed treatment whereas 27 (7%) participants discontinued IPT due to the side effects of INH. Conclusion This is the first study to evaluate the prevalence of LTBI and feasibility of IPT among Thai prisoners. LTBI prevalence in male prisoners in Thailand is high. LTBI screening and treatment should be implemented together with other preventive components.

Plastic deformations in kyanites by tectonometamorphic processes: a single-crystal X-ray diffraction study

2009 ◽  
Vol 73 (3) ◽  
pp. 359-371 ◽  
Author(s):  
G. D. Gatta ◽  
N. Rotiroti ◽  
M. Zucali
Keyword(s):  
Single Crystal ◽  
X Ray Diffraction ◽  
Plastic Deformations ◽  
X Ray ◽  
Deformational History ◽  
Significant Difference ◽  
Elliptical Section ◽  
History Of ◽  
Diffraction Patterns ◽  
Two Stages

AbstractThe crystalch emistry and crystal structure of naturalky anite crystals from the Eclogitic Micaschists Complex of the Sesia-Lanzo Zone, Western Italian Alps, have been investigated by means of optical microscopy, wavelength dispersive X-ray microanalysis, and single-crystal X-ray diffraction. The association of kyanite + garnet + phengitic-mica + chloritoid suggests that the eclogite-facies stages occurred at P ≤ 2.1 GPa and T ≤ 650ºC. Kyanite grains are large (cm-sized) porphyroblasts grown dynamically during one of the deformational events related to the subduction of the Austroalpine continentalcr ust. Under the polarizing microscope, kyanite grains show almost homogeneous cores, whereas rims are sometimes symplectitic aggregates of quartz and kyanite, confirming at least two stages of growth most likely related to the multistage deformational history of these rocks. Chemical analysis shows that Fe3+ is the major substituting cation for Al3+, ranging between 0.038 and 0.067 a.p.f.u.The single-crystal X-ray diffraction investigation of the kyanites shows severely textured patterns on the (h0l)*-plane. Such evidence is not observed in the unwarped diffraction patterns on (0kl)* and (hk0)*. The most significant difference between the structuralp arameters refined in this study, with respect to those of previously published unstrained gem-quality crystals, concerns the displacement parameters. The anisotropic displacement ellipsoids of all the atomic sites are significantly larger than those previously described, and systematically oriented with the largest elliptical section almost perpendicular to [010]. The larger ellipsoids in the kyanite crystal investigated here reflect the displacement of the centre of gravity of the electron distribution, rather than an anomalous atomic thermal motion. The magnitude and orientation of the displacement parameters and the textured/strained diffraction pattern may be the result of two combined effects: (1) that the kyanite crystals are actually composed of several blocks; (2) the crystals are affected by a pervasive residual strain, as a result of tectonometamorphic plastic deformations and re-crystallization.

scholarly journals Interleukin-37 as an anti-inflammatory cytokine: does its relation to disease activity suggest its potential role in rheumatoid arthritis therapy?

2021 ◽  
Vol 48 (1) ◽  
Author(s):  
Eman A. Baraka ◽  
Mona G. Balata ◽  
Shereen H. Ahmed ◽  
Afaf F. Khamis ◽  
Enas A. Elattar
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Cross Sectional Study ◽  
Healthy Controls ◽  
Tender Joint ◽  
Cross Sectional ◽  
Reactive Protein ◽  
Significant Difference ◽  
The Mean ◽  
Anti Inflammatory

Abstract Background This study aimed to measure the serum and synovial interleukin (IL)-37 levels in rheumatoid arthritis (RA) patients compared to patients with primary knee osteoarthritis (PKOA) and healthy controls and to detect its relation to RA disease activity. Results This cross-sectional study included 50 RA patients with a mean age of 40.24 ± 8.62 years, 50 patients with PKOA with a mean age of 56.69 ± 4.21, and 40 healthy controls with a mean age of 41.75 ± 7.38 years. The mean serum IL-37 level in the RA patients (382.6 ± 73.97 pg/ml) was statistically significantly (P < 0.001) the highest among the studied groups; however, it showed a non-significant difference between the PKOA patients (70.38 ± 27.49 pg/ml) and the healthy controls (69.97 ± 25.12 pg/ml) (P > 0.94). Both serum and synovial IL-37 levels were significantly positively correlated with disease activity scores (r = 0.92, P< 0.001 and r = 0.85, P < 0.001), tender joint counts (r = 0.83, P < 0.001 and r = 0.82, P < 0.001 ), swollen joint counts (r = 0.72, P < 0.001 and r = 0.60, P < 0.001), visual analog scale (r = 0.82, P < 0.001 and r = 0.82, P < 0.001), erythrocyte sedimentation rate (r = 0.75, P < 0.001 and r = 0.65, P < 0.001), and C-reactive protein (r = 0.93, P < 0.001 and r = 0.79, P < 0.001), respectively. Conclusion Serum and synovial IL-37 were significantly elevated in the RA patients, and they were closely correlated. Being less invasive, the serum IL-37 could be a marker of disease activity and could reflect the effective disease control by drugs. Having an anti-inflammatory effect could not suggest IL-37 as the key player to control inflammation alone, but its combination with other anti-proinflammatory cytokines could be investigated.

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