The lung and its contiguous structures are commonly involved in several of the rheumatic diseases (Table 1), either by direct manifestation of disease or as a secondary effect from infection or complications of therapy. In this chapter, we detail the various pulmonary manifestations of the major rheu- matological conditions. The common symptoms of pulmonary diseases and how frequently they are implicated in rheumatic disorders are review- ed. In addition, radiology and physiology of the lung, diagnostic proce- dures and therapeutic options are discussed. Table l.
Respiratory associations of the rheumatic disorders Disease Airways Parenchyma Vessels WalVmuscles Lung Pleura Pulmonary Chest pleurisy hypertension Rheumatoid bronchiectasis, pneumonia, arthritis obliterative fibrosing effusion bronchiolitis alveolitis, empyema nodules Systemic pneumonia pleurisy hypertension lupus fibrosing effusion shrinking lungs erythematosus alveolitis, with high atelectasis diaphragm Systemic bronchiectasis fibrosing hypertension "encased chest" sclerosis alveolitis, aspiration pneumonia Sjogren's bronchitis fibrosing alveolitis syndrome lymphoma Dermatomyositis aspiration myopathy polymyositis pneumonia, fibrosing alveolitis Ankylosing upper lobe cos- spondylitis fibrosis vertebral fixation joint Behget's haemorrhage aneurysm syndrome Relapsing upper airway polychondritis narrowing Pulmonary vasculitides nodules The Respiratory System in Rheumatic Diseases 25 1. 2. Respiratory Symptoms The most common respiratory symptoms in patients with rheumatic disease and pulmonary involvement are non-specific and include cough, breathlessness and chest pain and can be the result of involvement of air- ways, lung parenchyma, pleura, chest wall or pulmonary vessels. 1.
3. Tissue Involvement 1. 3. 1.