Email this article Pneumonia in patients with rheumatoid arthritis: the frequency of development, the specific features of its course and risk factors
- Authors: Polyanskaya M.V.1, Belov B.S.1, Balabanova R.M.1, Polyanskaya MV2, Belov BS2, Balabanova RM2
-
Affiliations:
- Research Institute of Rheumatology, Russian Academy of Medical Sciences
- Issue: Vol 82, No 5 (2010)
- Pages: 29-33
- Section: Editorial
- URL: https://ter-arkhiv.ru/0040-3660/article/view/30576
- ID: 30576
Cite item
Full Text
Abstract
Aim. To study the frequency of development of pneumonia, the specific features of its course and risk factors (RF) in inpatients with rheumatoid arthritis (RA).
Materials and methods. The archival records (a total of 9059 case histories) of patients with RA treated at the Institute of Rheumatology, Russian Academy of Medical Sciences, during 7 calendar years (1994-1996, 2003-2006) were retrospectively studied. Case histories containing evidence for pneumonia sustained during the patient's hospital stay were selected for analysis. During the analysis, the authors took into account the clinical characteristics of RA, laboratory and X-ray parameters, and comorbidity, including pneumonia.
Results. In the inpatients, the frequency of development of pneumonia was 0.8%. The risk factors of pneumonia were the high activity of RA, its systemic manifestations and no use of essential antirheumatic drugs. In 70% of RA patients developing pneumonia, the body temperature was normal or subfebrile; productive cough was absent in 50% of the patients; a third had no cough. Clear X-ray lung tissue infiltration was seen in 48% of cases. Clinical leukocytosis was absent in 50% of the patients; at the same time, there were statistically significant increases in the count of stab neutrophils and erythrocyte sedimentation rate.
Conclusion. The inpatients with RA develop pneumonia in about 0.8% of cases, which is characterized by an obliterated course and usually develops with the high activity of RA, its systemic manifestations and no use of essential antirheumatic drugs.
Materials and methods. The archival records (a total of 9059 case histories) of patients with RA treated at the Institute of Rheumatology, Russian Academy of Medical Sciences, during 7 calendar years (1994-1996, 2003-2006) were retrospectively studied. Case histories containing evidence for pneumonia sustained during the patient's hospital stay were selected for analysis. During the analysis, the authors took into account the clinical characteristics of RA, laboratory and X-ray parameters, and comorbidity, including pneumonia.
Results. In the inpatients, the frequency of development of pneumonia was 0.8%. The risk factors of pneumonia were the high activity of RA, its systemic manifestations and no use of essential antirheumatic drugs. In 70% of RA patients developing pneumonia, the body temperature was normal or subfebrile; productive cough was absent in 50% of the patients; a third had no cough. Clear X-ray lung tissue infiltration was seen in 48% of cases. Clinical leukocytosis was absent in 50% of the patients; at the same time, there were statistically significant increases in the count of stab neutrophils and erythrocyte sedimentation rate.
Conclusion. The inpatients with RA develop pneumonia in about 0.8% of cases, which is characterized by an obliterated course and usually develops with the high activity of RA, its systemic manifestations and no use of essential antirheumatic drugs.
Keywords
About the authors
Miroslava Valer'evna Polyanskaya
Email: mpolyanskaya@yandex.ru
Boris Sergeevich Belov
Rimma Mikhaylovna Balabanova
M V Polyanskaya
Research Institute of Rheumatology, Russian Academy of Medical SciencesResearch Institute of Rheumatology, Russian Academy of Medical Sciences
B S Belov
Research Institute of Rheumatology, Russian Academy of Medical SciencesResearch Institute of Rheumatology, Russian Academy of Medical Sciences
R M Balabanova
Research Institute of Rheumatology, Russian Academy of Medical SciencesResearch Institute of Rheumatology, Russian Academy of Medical Sciences
References
- Каратеев Д. Е., Иванова М. М., Балабанова Р. М., Акимова Т. Ф. Анализ летальных исходов ревматоидного артрита при длительном наблюдении. Рос. ревматол. 1998; 1: 17- 28.
- Чучалин А. Г., Синопальников А. И. (ред.). Клинические рекомендации. Внебольничная пневмония у взрослых. М.: Атмосфера; 2005.
- Falagas M. E., Manta K. G., Betsi G. L, Pappas G. Infection-related morbidity and mortality in patients with connective tissue diseases: a systematic review. Clin. Rheumatol. 2007; 26 (5): 663-670.
- Koivuniemi R., Leirisalo-Repo M., Suomalainen R. et al. Infectious causes of death in patients with rheumatoid arthritis: an autopsy study. Scand. J. Rheumatol. 2006; 35; 273-276.
- Peltomaa R., Paimela L., Kautiainen H., Leirisalo-Repo M. Mortality in patients with rheumatoid arthritis treated actively from the time of diagnosis. Ann. Rheum. Dis. 2002; 61: 889- 894.
- Wolfe F., Mitchell D. M., Sibley J. T. et al. The mortality of rheumatoid arthritis. Arthr. and. Rheum. 1994; 37 (4): 481- 494.
- Bernatsky S., Hudson M., Suissa S. Anti-rheumatic drug use and risk of serious infections in rheumatoid arthritis. Rheumatology 2007; 46: 1157-1160.
- Franklin J., Lunt M., Bunn D. et al. Risk and predictors of infection leading to hospitalisation in a large primary-care-derived cohort of patients with inflammatory polyarthritis. Ann. Rheum. Dis. 2007; 66: 308-312.
- Gluck T., Kiefmann B., Grohmann M. et al. Immune status and risk for infection in patients receiving chronic immunosuppressive therapy. J. Rheumatol. 2005; 32 (8): 1473-1480.
- Kroesen S., Widmer A. F., Tyndall A., Hasler P. Serious bacterial infections in patients with rheumatoid arthritis under anti-TNFα-therapy. Rheumatology 2003; 42; 617-621.
- Reddy S., Wanchu A., Gupta V., Bambery P. Profile of opportunistic infections among patients on immunosuppressive medication. APLAR J. Rheumatol. 2006; 9: 269-274.
- Coyne P., Hamilton J., Heycock C. et al. Acute lower respiratory tract infections in patients with rheumatoid arthritis. J. Rheumatol. 2007; 34 (9): 1832-1836.
- Doran M. F., Crowson C. S., Pond G. R. et al. Frequency of infection in patients with rheumatoid arthritis compared with controls. A population-based study. Arthr. and Rheum. 2002; 46 (9): 2287-2293.
- Huskisson E. C., Hart F. D. Severe, unusual, and recurrent infections in rheumatoid arthritis. Ann. Rheum. Dis. 1972; 31: 118-121.
- Wolfe F., Caplan L., Michaud K. Treatment for rheumatoid arthritis and the risk of hospitalization for pneumonia. Arthr. and Rheum. 2006; 54 (2): 628-634.
- Doran M. F., Crowson C. S., Pond Q. R. et al. Predictors of infection in rheumatoid arthritis. Arthr. and Rheum. 2002; 46 (9): 2294-2300.
- van Albada-Kuipers G. A., Linthorst J., Peeters E. A. J. et al. Frequency of infection among patients with rheumatoid arthritis versus patients with osteoarthritis or soft tissue rheumatism. Arthr. Rheum. 1988; 31: 667-671.
- Stuck A. E., Minder C. E., Frey F. J. Risk of infectious complications in patients taking glucocorticosteroids. Rev. Infect. Dis. 1989; 11 (6): 954-963.
- Lacaille D., Guh D. P., Abrahamowicz M. et al. Use of nonbiologic disease modifying antirheumatic drugs and risk of infection in patients with rheumatoid arthritis. Arthr. and Rheum. (Arthr. Care Res.) 2008; 59 (8): 1074-1081.
- Smitten A. L., Choi H. K., Hochberg M. C. et al. The risk of hospitalized infection in patients with rheumatoid arthritis. J. Rheumatol. 2008; 35 (3): 387-393.
- Franquet T. Imaging of pneumonia: trends and algorithms. Eur. Respir. J. 2001; 18: 196-208.
- Синопальников А. Острый бронхит. Врач 2007; 5: 13-19.
- Ortqvist A. Treatment of community-acquired lower respiratory tract infections in adults. Eur. Respir. J. 2002; 20 (suppl. 36): 40-53.
Supplementary files
