Updated:
Save
Osteoarthritis or arthritis? Many people confuse them, but they are not the same disease. Rheumatoid arthritis is a chronic inflammatory disease that affects approximately 200,000 people in Spain. And, contrary to what one might think, it afflicts people of any age, although it usually occurs between 45 and 55 years of age, and is more frequent in women.
When most people think of her, they think of her symptoms on the joints, especially in the hands. And while it preferentially affects joints on both sides of the body, for example both wrists, it can also damage internal organs such as the lungs.
«Rheumatoid arthritis is one of the most common chronic pathologies of autoimmune origin.points out Dr. Gemma Bonilla, rheumatologist at Hospital la Paz in Madrid.
“It is a systemic disease, although there really is a predilection for the musculoskeletal system, it can affect different organs and systems, including the lung.”
In fact, he points out, its effects on the respiratory system are quite frequent and it constitutes one of the main causes of morbidity and premature mortality. Remember the Dr. Bonilla that about 50% of patients may have symptoms that affect other organs, such as the lung.
This means that, due to the high impact on the quality of life of those who suffer from it, early diagnosis is essential, but it is also essential to recognize potential complications.
Especially important, recalls this expert, has been this diagnosis in the SARS-CoV-2 virus pandemic, due to the susceptibility of RA patients to infectious conditions that can generate high morbidity and mortality.
However, RA can be difficult to diagnose in its early stages, as symptoms can resemble other diseases.
No blood test alone can confirm a diagnosis; now some bookmarks (ESR) or C-reactive protein (CRP) can indicate the presence of increased inflammation in the body. Likewise, testing for autoantibodies that can play a predictive role in its development can detect patients at higher risk.
Because, although there is no curative treatment, there are therapies that manage to stop the evolution of the disease and keep it inactive, thus avoiding the consequences of persistent inflammation.
And this is where an early diagnosis is key to start treatment as soon as possible. It should not be forgotten that the first two years of the disease are key to improving the functional prognosis of patients.
It must be taken into account that if the inflammation is maintained over time it can lead to joint destruction and progressive disability.
Among the most serious complications that affect the lung, stresses Dr. Bonilla, it is «extremely relevant early diagnosis of diffuse interstitial lung disease (DILD), one of the most frequent and severe extra-articular manifestations of RA».
The rheumatologist assures that it is more “common in men, the elderly, those with late-onset RA, those with a history of smoking or those with a series of positive immunological markers.”
Although the prevalence of symptomatic ILD varies between 10% and 40%, it is currently the second leading cause of death in RA, after cardiovascular complications. And, in fact, Dr. Bonilla points out, “we have the feeling that we are diagnosing this manifestation in RA more and more frequently and this is undoubtedly due to the fact that we are becoming more aware of how important it is”.
How to diagnose ILD?
Dr. Bonilla explains that it is essential to suspect it in patients with RA with positive FR and ACPA markers, generally over 40 years of age and smokers, who notice dyspnea (a feeling of shortness of breath) or chronic cough.
It is also important to carry out diagnostic tests to find out if you suffer from this complication and to assess its activity and extension; early diagnosis and the establishment of adequate treatment are essential to stop the process and prevent untreated pulmonary inflammation from leading to a state of pulmonary fibrosis that is much more difficult to treat.
Dr. Bonilla adds that on many occasions they take time to appear in such a way that in some cases it is detected when it is already highly evolved. For this reason, she emphasizes that it is important to monitor these patients periodically. «And that includes pulmonary auscultation, because we can find crackles». Crackles are small popping, bubbling, or crashing noises in the lungs that are heard when a person inhales.
In this sense, ILD screening criteria endorsed by the Spanish Society of Rheumatology and the Spanish Society of Pulmonology and Thoracic Surgery have recently been published with the aim of early identification of patients so that they can be referred to the Rheumatology and Pulmonology services. .
There is no cure for rheumatoid arthritis; current treatment options are focused on reducing symptoms and include nonsteroidal anti-inflammatory drugs (NSAIDs), and disease-modifying corticosteroids (DMARDs).
See them
comments