Signs of pulmonary damage according to X-ray examinations data in rheumatic arthritis patients with different serological profile


DOI: https://dx.doi.org/10.18565/therapy.2019.6.35-43

Nesterovich I.I., Nochevnaya K.V., Rabik Y.D., Vasina L.V., Speranskaya A.A., Zolotnitskaya V.P., Amosov V.I., Trofimov V.I., Vlasov T.D.

I.P. Pavlov First St. Petersburg State medical University of the Ministry of Healthcare of Russia
Objective: to evaluate the impact of serological profile on presence and severity of lung injury in patients with rheumatoid arthritis (RA).
Material and methods. 104 patients with RA were enrolled in the study. Persons with pulmonary comorbidity were excluded. Lung abnormalities in patients with RA were detected by high resolution computed tomography (HRCT). For evaluation of vascular disorders single photon emission computed tomography (SPECT) of lungs was performed. Serological profile of the patient was determined with positivity for rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (anti-CCP).
Results. HRCT didn’t show any difference in severity of lung injuries between seropositive and seronegative for RF/anti-CCP patients. However,
anti-CCP-positive RA was associated with the presence of rheumatoid lung nodules (p = 0,041), and anti-CCP-negative – with pulmonary hypertension (p = 0,023). There was no difference in vascular disorders among RF-positive and negative patients. Also SPECT revealed significant decrease of lung perfusion in anti-CCP-negative patients compared with anti-CCP-positive (p = 0.037).
Conclusion. Serological profile of patients with RA determines the frequency and severity of lung injuries including interstitial, bronchial and vascular abnormalities. High titers of RF and anti-CCP are risk factors of clinically manifested RA-associated interstitial lung disease. RF- and anti-CCP-negative patients usually have bronchial injury and pulmonary hypertension, while interstitial lung disease tends to be subclinical in this group.
Keywords: single-photon emission computed tomography, rheumatoid factor, lung injury, autoantibodies, rheumatoid arthritis, computed tomography
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About the Autors

Irina I. Nesterovich, MD, professor of the Department of hospital therapy with a course of allergology and immunology named after M.V. Chernorutsky of I.P. Pavlov First St. Petersburg State medical University of the Ministry of Healthcare of Russia. Address: 197022, St. Petersburg, 6/8 Leo Tolstoy Str. Tel.: +7 (812) 338-60-87. Е-mail: nester788@gmail.com
Ksenia V. Nochevnaya, PhD, assistant of the Department of pathophysiology with a course of clinical pathophysiology of I.P. Pavlov First St. Petersburg State medical University of the Ministry of Healthcare of Russia. Address: 197022, St. Petersburg, 6/8 Leo Tolstoy Str. Tel.: +7 (812) 338-70-35. Е-mail: k.nochevnaya@mail.ru
Yulia D. Rabik, PhD, head of functional diagnostics Department No. 2 of Scientific-clinical Center Clinic of I.P. Pavlov First St. Petersburg State medical University of the Ministry of Healthcare of Russia. Address: 197022, St. Petersburg, 6/8 Leo Tolstoy Str. Tel.: +7 (812) 338-78-29. Е-mail: rabjul@yandex.ru
Lyubov V. Vasina, MD, professor, head of the Department of biochemistry of I.P. Pavlov First St. Petersburg State medical University of the Ministry of Healthcare of Russia. Address: 197022, St. Petersburg, 6/8 Leo Tolstoy Str. Tel.: +7 (812) 338-70-09. Е-mail: lubov.vasina@gmail.com
Alexandra A. Speranskaya, MD, professor of the Department of radiology and radiation medicine of I.P. Pavlov First St. Petersburg State medical University of the Ministry of Healthcare of Russia. Address: 197022, St. Petersburg, 6/8 Leo Tolstoy Str. Tel.: +7 (812) 338-63-03. Е-mail: a.spera@mail.ru
Valentina P. Zolotnitskaya, Doctor of biology, senior scientist of Research Institute of pulmonology of I.P. Pavlov First St. Petersburg State medical University of the Ministry of Healthcare of Russia. Address: 197022, St. Petersburg, 6/8 Leo Tolstoy Str. Tel.: +7 (812) 338-63-03. Е-mail: vikt-amosov@yandex.ru
Victor I. Amosov, MD, professor, head of the Department of radiology and radiation medicine of I.P. Pavlov First St. Petersburg State medical University of the Ministry of Healthcare of Russia. Address: 197022, St. Petersburg, 6/8 Leo Tolstoy Str. Tel.: +7 (812) 338-63-08. Е-mail: vikt-amosov@yandex.ru
Vasili I. Trofimov, MD, professor, head of the Department of hospital therapy with a course of allergology and immunology named after M.V. Chernorutsky of I.P. Pavlov First St. Petersburg State medical University of the Ministry of Healthcare of Russia. Address: 197022, St. Petersburg, 6/8 Leo Tolstoy Str. Tel.: +7 (812) 338-67-46. Е-mail: trofvi@mail.ru
Timur D. Vlasov, MD, professor, head of of the Department of pathophysiology with a course of clinical pathophysiology of I.P. Pavlov First St. Petersburg State medical University of the Ministry of Healthcare of Russia. Address: 197022, St. Petersburg, 6/8 Leo Tolstoy Str. Tel.: +7 (812) 338-70-61. Е-mail: tvlasov@yandex.ru


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