What Is Rheumatoid Lung Disease?

Rheumatoid arthritis may be related to infection, endocrine disorders, impaired blood flow, immune system factors, genetic factors, and rheumatic cold factors in traditional Chinese medicine.

Pulmonary rheumatoid disease

Rheumatoid arthritis may be related to infection, endocrine disorders, impaired blood flow, immune system factors, genetic factors, and rheumatic cold factors in traditional Chinese medicine.

Chinese name

Pulmonary rheumatoid disease

Causes

Infections, endocrine disorders, and blood flow disorders

Pathogenesis

Results of immune response stimulated by the body

Types of

Humoral immunity

The cause of rheumatoid arthritis is not clear at present, and it may be related to infection, endocrine disorders, blood transport disorders, immune system factors, genetic factors and rheumatic cold factors in Chinese medicine. The pathogenesis is the result of the body's immune response to antigen stimulation, which includes both humoral and cellular immunity [2]. The former is mainly due to the denaturation of the special antibody IgG produced by plasma cells to obtain antigenicity, and then stimulate the body to produce IgM, IgG or IgA antibodies; that is, rheumatoid factors and form antigen-antibody immune complexes, thereby activating the complement system and attracting a large number of Immune responses occur in neutrophils and macrophages; the latter are mainly a large number of T cell dysfunctions, including helper T cells (CD4) and suppressor T cells (CD8). Rheumatoid arthritis is a disease of connective tissue (ie, collagenous disease), which is concentrated in the collagen fibers and matrix of connective tissue in certain organs of the body. Because connective tissue is widely distributed throughout the body, rheumatoid arthritis can invade various organs of the body at different times; such as the lungs, pleura, blood vessels, joints, and so on. Lesions in the lungs occur in the connective tissue of the bronchial wall, the lungs and the bronchial arterial wall, connective tissue in the lung parenchyma, and in the pleura. Connective tissues, like lymph nodes, are immune organs with an immune response. Due to the imbalance of the interaction between immune regulation and lymphocyte subgroups and other factors, connective tissue edema, hyperplasia, and small blood vessels increase, and a large number of inflammatory cells accumulate.

The pathological basis of lung and pleura caused by rheumatoid disease is mainly the abnormal immune response of connective tissue. The basic pathological changes of connective tissue after injury can be summarized into four aspects, that is, myxedema, fibrinoid necrosis, inflammatory cell infiltration, and fibrosis. The lesions caused by the lung and pleura can be divided into the following manifestations: (1) pleural effusion; (2) extensive interstitial pulmonary fibrosis; (3) progressive necrotic nodules; (4) Caplan syndrome; (5) Acute pneumonia.

3.2.1 pleurisy and pleural effusion

The basic pathological changes are lymphocytic fibrous exudation, which is the most common in chest X-ray changes, and it is more common in male patients. Pleural effusion can occur before the onset of arthritis symptoms. It is often clinically asymptomatic and found only on X-ray examination, but most often occur when the onset of arthritis symptoms worsens. The effusion is generally small, occasionally a large amount of pleural effusion, unilateral or bilateral, the length of time that the effusion is absorbed varies, and pleural adhesion or thickening may gradually occur. In this article, there are 5 cases of pleural hypertrophy. Seen in the tablets, the effusion was absorbed slowly or was not absorbed for a long time.

3.2.2 Extensive interstitial pulmonary fibrosis

The pathological basis is mainly fibrosis of the alveolar wall and lobular septum. It is the most common lung disease and is found in about 30% of patients. Some scholars believe that the ratio of male to female incidence is 2: 1, and this article is the same. This change developed gradually. In the early X-rays, only pulmonary veins were thickened, increased, stiff, and the edges were blurred and disordered. As the disease progressed, non-specific interstitial pneumonia was associated with fibrosis in the lungs after pneumonia was absorbed. The lesions gradually develop into diffuse irregular linear, reticular or reticular-nodular shadows in the late stages, which are more obvious at the base of the lungs, and even form a honeycomb change. There is often necrosis in the middle of the nodular shadow, which helps to distinguish it from idiopathic extensive interstitial pulmonary fibrosis. Honeycomb changes were found in 2 of the 18 patients in this article, which is basically similar to Zou Zhengjia's report. As the course of the disease develops, it is often accompanied by a small amount of effusion and the pleura thickens and adheres. This is the result of concurrent bronchiectasis, leading to severe impairment of lung function. Two cases of bronchiectasis complicated with pleural thickening were seen in this article, and the course of disease was more than 3 to 4 years. In addition, honeycomb changes can form bullae and pneumothorax.

3.2.3 Progressive Necrotic Nodules

The pathological basis is fibrinoid degeneration or necrotic tissue in the center of the nodule, which contains cellulose and immune complexes deposited, histological cells arranged in a grid-like arrangement on the edge, and granulation tissue infiltrated by monocytes in the outer layer. Pathologically, progressive lung necrotic nodules are exactly the same as subcutaneous rheumatoid nodules. X-rays are distributed in the periphery of the lung or in the lower and middle fields of the lung, single or multiple, with clear outlines, high-density nodule shadows, different sizes, a few millimeters, and a large diameter of 5-6 cm, with 0.5 1.5cm is more common. Thick thick-walled cavities with smooth inner walls often appear in nodules. The size and shape of the nodules change according to the filling of the cavities, and vary with the degree of arthritis activity. When the symptoms of arthritis improve, The cavity wall can become thin or even disappear. Conversely, the cavity can be refilled to become a dense shadow. Such changes are rare, and most often occur in patients with high rheumatoid factor titers and subcutaneous nodules. The 6 cases in this article were all found in patients with strong rheumatoid factor (IgM) positive and subcutaneous nodules. Therefore, progressive necrotic nodules mostly appear in patients with severe rheumatoid arthritis.

3.2.4 Caplan syndrome

That is rheumatoid arthritis, rheumatoid nodules, and inorganic pneumoconiosis. More common in coal mine workers, asbestos, silica dust, ceramics and other workers can also occur. The two cases in this article are coal miners. Dust may have an adjuvant effect, stimulating the production of antibodies (rheumatoid factor), and it may also be a local stimulus and injury, which is conducive to the formation of rheumatoid granuloma. Rheumatoid granulomas, or rheumatoid nodules, are single or multiple circular lesions, about 0.5 to 5.0 cm in size, with a clear outline and can be distributed in both lungs. Such nodules can appear before, at the same time as, or after the onset of arthritis symptoms, and appear continuously in short-term follow-up observations. The number gradually increases, can also remain unchanged for a long time, or develop fibrosis, calcification or formation of cavities. Can disappear completely. Both cases in this article occurred before the onset of arthritis symptoms. When examining the pneumoconiosis, it was found that the nodules were located in the middle and lower fields of the lungs, accompanied by pulmonary vein texture, and the size was about 0.5 to 3.0 cm. Rheumatoid factor is strongly positive. Unlike silicosis nodules, the latter are mostly dense, isolated shadows that separate from the lung texture and are about 0.3 cm in size.

3.2.5 Acute pneumonia

The pathological basis may be that during the exudation phase of interstitial pneumonia, the alveolar cavity is filled with edema fluid, lymphocytes, plasma cells and transparent membranes. The X-ray showed flaky cloud-like shadows with blurred edges. One case was a female. The lesions did not improve after 1 week of anti-infective treatment, and the effect was better after switching to hormone therapy. After absorption of patchy shadows, stripe shadows remain, and the unchanged lesions for more than 1 year may be caused by pulmonary fibrosis.

In short, rheumatoid arthritis causes a higher proportion of lung and pleural damage. It has been reported to account for 42.8%, and the incidence of this article is 37.3%, which is slightly lower than this, and may not take into account myocardial disease. The chest disease does not occur in isolation, but a certain disease is the main sign, and coexist with other changes. The timely and correct diagnosis of pulmonary rheumatoid disease has certain clinical significance for the treatment and prediction of rheumatoid arthritis. It has been reported that patients with small or no lung lesions have good drug treatment. Pulmonary lesions appear more or earlier, and drug treatment is less effective. This article reports that in all patients, the treatment of a single sign of the lung is better, and the symptoms are controlled or cured within 1 to 2 years. The lung signs appeared early and the compound signs were less effective. The course of disease was over 3 years and even up to 13 years. Therefore, patients with rheumatoid arthritis should take chest radiographs before the onset of pulmonary symptoms or have pulmonary symptoms, so that early detection and timely treatment can prevent the deterioration of the disease and complications.