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Characterisation of severe obliterative bronchiolitis in rheumatoid arthritis.

Abstract : The characteristics of patients with rheumatoid arthritis (RA) who develop obliterative bronchiolitis characterised by severe airflow obstruction have been hitherto poorly investigated. A retrospective study of 25 patients with RA and functional evidence of obliterative bronchiolitis (forced expiratory volume in one second (FEV(1))/forced vital capacity (FVC) <50% and/or residual volume (RV)/total lung capacity (TLC) >140% predicted) was conducted. Patients (mean+/-SD age 64+/-11 yrs) included 17 never-smokers and eight ex-smokers (10.5+/-5.4 pack-yrs). The diagnosis of RA preceded respiratory symptoms in 88% of cases. Dyspnoea on exertion was present in all patients and bronchorrhea in 44%. High-resolution computed tomography findings included: bronchial wall thickening (96%), bronchiectasis (40%), mosaic pattern (40%), centrilobular emphysema (56%), and reticular and/or ground-glass opacities (32%). Pulmonary function tests showed: FEV(1) 41+/-12% pred, FEV(1)/FVC 49+/-14%, FVC 70+/-20% pred, RV 148+/-68% pred and RV/TLC 142+/-34% pred. Lung biopsy, available in nine patients, demonstrated constrictive, follicular and mixed bronchiolitis. Patients were followed for 48.2+/-49 months. Treatment was poorly effective. Chronic respiratory failure occurred in 40% of patients, and four patients died. Obliterative bronchiolitis associated with rheumatoid arthritis is a severe and under-recognised condition leading to respiratory failure and death in a high proportion of patients.
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Contributor : Ghislaine Calvez Connect in order to contact the contributor
Submitted on : Tuesday, December 31, 2013 - 3:56:21 PM
Last modification on : Friday, August 5, 2022 - 3:42:36 AM

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G. Devouassoux, V. Cottin, H. Lioté, E. Marchand, I. Frachon, et al.. Characterisation of severe obliterative bronchiolitis in rheumatoid arthritis.. European Respiratory Journal, 2009, 33 (5), pp.1053-61. ⟨10.1183/09031936.00091608⟩. ⟨hal-00922939⟩



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