Lung Lesions in Rheumatoid Arthritis
Authors: A. Aronoff, E. G. L. Bywaters, G. R. Fearnley
Journal: BMJ (1955)

Pulmonary changes, varying from pleural effusions, pleural thickening, mottling, reticulation, and chronic fibrosis have been observed in patients with   (Weir, 1939; Elkeles, 1944; Miller and Daley, 1946; Tumulty and Harvey, 1949; Murphy et al., 1941; Weiss et al., 1943 ; Littler, 1953). A number of authors have noted similar changes in patients with  arthritis (Ellman, 1947; Ellman and Ball, 1948; Hart, 1948; Leys and Swift, 1949; Schlesinger, 1949; Bloom and Rubin, 1950; Christie, 1954; Harris, 1954), where no other specific cause for these changes could be un covered. Ellman and Ball (1948) coined the terms rheumatoid  and rheumatoid  to in dicate that these pulmonary changes were another manifestation of connective-tissue involvement similar to that seen in the joints and in nodules of patients with  arthritis, thus indicating the widespread nature of the process in this condition. More recently Ellman and Cudkowicz (1954) de scribed a group of signs and symptoms in these patients which they labelled the   lung  characterized by cough, fever, and dyspnoea, frequently associated with an exacerbation of arthralgia. The x-ray changes observed were multiform, as described in other collagen diseases. The degree of dyspnoea was often greater than the clinical signs and x-ray findings sug gested. Fever, leucocytosis, and arthralgia might or might not accompany the onset of pulmonary symptoms. The signs and symptoms were unaffected by anti rheumatic or antibiotic therapy and resolved slowly, leaving residual fibrosis and pleural thickening. Caplan (1953) described, in coal-miners, a syndrome of nodular lung fibrosis which was associated with  arthritis in more than 50% of cases; and it was also suggested that the prevalence of  arthritis was increased amongst men with complicated pneumoconiosis (Miall et al., 1953). In a further study Miall (1955) has raised again the question of an associa tion between  arthritis and tuberculosis. His data suggest that a relationship between the two diseases may exist, and that this relationship is due to some alteration in tissue reaction which is often of genetic origin and perhaps a component of the so-called   matoid diathesis. In our experience at the Postgraduate Medical School over the last 15 years we have not noticed any specific lung lesions in patients with  arthritis, and we have not encountered any instances of the rheu matoid lung syndrome. We have learnt to recognize lung lesions in allied diseases such as the fibrosis of scleroderma (Shuford et al., 1953) and the interstitial infiltrations of periarteritis nodosa and lupus erythema tosus (Rakov and Taylor, 1942). We recognize, but have not personally encountered, the very rare occurrence of  nodules in the lung, of the type described by Raven et al. (1948). We have also, with Dr. Griffith Pugh, investigated a patient with a lung lesion associated with Sjogren's syndrome, described by Ellman and Weber (1949). Rheumatoid arthritis is a disease that primarily affects the joints-a local disease, affecting some joints and not others, whose economic and human importance depends upon its predilection for synovial membrane. It is a common disease affecting, according to Kellgren et al. (1953), approximately 2 % in some samples of the population, and many of our patients have had non-specific lung lesions. We have therefore analysed our clinical and pathological experience to determine how often lung lesions occur in patients with  arthritis and to see how this compares with the incidence in other hospital material.