Cenk BABAYİĞİT, Hayal GÜLER, Ertuğrul EĞİLMEZ, Sinem KARAZİNCİR, Sebahat AKOĞLU, Ali BALCI

Semptomsuz ve sigara içmeyen romatoid artritli hastalarda erken dönem akciğer tutulumunun yüksek rezolüsyonlu bilgisayarlı tomografi ile değerlendirilmesi

Bu çalışmanın amacı; solunum sistemi semptomu bulunmayan ve hayatı boyunca hiç sigara kullanmamış romatoid artritli (RA) hastalarda yüksek rezolüsyonlu bilgisayarlı tomografi (YRBT) ile pulmoner tutulumun değerlendirilmesidir. Çalışmaya, klinik olarak asemptomatik ve hayatı boyunca sigara kullanmamış 25 RA’lı hasta alındı. Klinik ve laboratuvar incelemeler yapıldıktan sonra, PA akciğer grafisi, solunum fonksiyon testi (SFT) ve YRBT tetkikleri yapıldı. Hava hapsini değerlendirmek için YRBT’de ekspiryum sonu kesitler elde edildi. PA akciğer grafisinde %12, SFT’de %16, YRBT’de %48 oranında anormallik saptandı. YRBT’de en sık olarak interstisyel akciğer hastalığı (İAH) ile uyumlu bulgular saptandı (%36). Hava hapsi ikinci sıklıkta saptadığımız bulgu (%20) idi. Hava hapsi ekspiryum sonu kesitlerde daha belirgindi. Bronşektazi %16, nodül %12, plevral tutulum %12 oranında izlendi. Hiçbir olguda amfizem ve bal peteği görünümü izlenmedi. Hastalık aktivite kriterleri, romatoid faktör pozitifliği, SFT sonuçları ve hastalık süresi ile YRBT bulguları arasında istatistiksel olarak anlamlı ilişki saptanmadı. RA olgularında akciğer tutulumunun her zaman solunum sistemi semptomuna ve solunum fonksiyon bozukluğuna yol açmadığı bu çalışma ile de gösterilmiştir. Asemptomatik, sigara içmemiş RA olgularında, radyolojik olarak akciğer tutulumunun saptanmasının sağkalımı tahmin etmede ya da tedavi kararında ne gibi etkiler yapabileceğini araştıran yeni çalışmalara gereksinim vardır.

The evaluation of early pulmonary involvement with high resolution computerized tomography in asymptomatic and non-smoker patients with rheumatoid arthritis

To investigate pulmonary involvement by high resolution computerized tomography (HRCT) in patients with rheumatoid arthritis (RA) who are asymptomatic and lifelong non-smoker. Twenty-five patients with RA who are asymptomatic and lifelong non-smoker were included in the study. After clinical and laboratory investigations, plain chest X-rays, pulmonary function tests (PFT) and HRCT were performed. End expiratory HRCT slices were obtained for air trapping. Chest X-ray, PFT and HRCT findings showed 12%, 16%, 48% abnormalities, respectively. Interstitial involvement was the most common finding on HRCT (36%) and followed by air trapping (20%). Bronchiectasis, pulmonary nodule, and pleural disease were seen in 16%, 12%, and 12% of patients, respectively. None of patients had emphysema and honeycomb pattern. There was no statistically significant correlation between HRCT findings and disease activity criteria, RF positivity, PFT results and duration of the disease. Our study shows that pulmonary involvement is not always together with respiratory symptoms and impaired pulmonary function in patients with RA. New studies are needed which investigating the effects of radiologically detected lung involvement on prediction of survival and treatment choice in asymptomatic and nonsmoker RA patients.

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