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Respiratory Disorders (Expert Forum)
Chest x-ray abnormalities, spondylarthropathy, and family history of pulmonary fibrosis
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Chest x-ray abnormalities, spondylarthropathy, and family history of pulmonary fibrosis
by crossbill, Jun 16, 2007 12:00AM
I'm a 62 year old female. Chest x-rays 10 years ago showed hyperinflation, mild fibrosis and mild apical pleural thickening. Spirometry has been normal but with FVC and FEV1 recently running around 80% and FEF 24-75% as low as 60% of predicted, but FEV1/FVC ratio >90% of predicted and PEF >110% of predicted. These tests were part of occupational health maintenance testing interpreted by a string of distant MDs; I got written reports of test results but no discussion of their meaning. My mother and maternal grandmother both died in their 80s of pulmonary fibrosis complications (pneumonia and cor pulmonale) after many years of worsening breathlessness. I have a 20+ pack year smoking history (but quit >20 years ago), a mild dry cough of 4-5 years duration, and a history of possible spondylarthropathy going back 40 years. Given the lack of treatment for idiopathic pulmonary fibrosis, I have sought no further medical opinion but only recently became aware of possible lung problems associated with spondylarthropathy. Should I consider seeing a pulmonologist or even perhaps a rheumatologist, given the recent advances in treating the spondylarthropathies?
Doctor's Answer
by National Jewish, Jun 22, 2007 12:00AM
, Jun 22, 2007 12:00AM
I did a careful literature search and could find no evidence of a relationship between spondylarthropathy and pulmonary disease, specifically no relationship to pulmonary fibrosis. There appears to be a relationship between this condition and kidney disease and inflammatory bowel disease and uveitis.
As for treatment, Phase III trials have confirmed that tumor necrosis factor antagonists are effective and safe for the treatment of ankylosing spondylitis and psoriatic arthritis. For patients who do not respond to tumor necrosis factor blockade, several treatment options are under study. Information from these trials will more clearly define the role of disease-modifying anti-rheumatic medicines, novel therapeutic agents, and antibiotics in the treatment of spondylarthropathy.
The FEV1 and FVC at 80% are borderline within normal limits. The FEV1/FVC ratio is high, a finding ordinarily associated with restrictive disease, of which pulmonary fibrosis is one. These most recent PFTs should be interpreted only in comparison to previous PFTs and PFTs to be repeated a year from now. If there is a question of restrictive disease, a chest x-ray should be done and if questionable, a CT scan of the chest.
As for treatment, Phase III trials have confirmed that tumor necrosis factor antagonists are effective and safe for the treatment of ankylosing spondylitis and psoriatic arthritis. For patients who do not respond to tumor necrosis factor blockade, several treatment options are under study. Information from these trials will more clearly define the role of disease-modifying anti-rheumatic medicines, novel therapeutic agents, and antibiotics in the treatment of spondylarthropathy.
The FEV1 and FVC at 80% are borderline within normal limits. The FEV1/FVC ratio is high, a finding ordinarily associated with restrictive disease, of which pulmonary fibrosis is one. These most recent PFTs should be interpreted only in comparison to previous PFTs and PFTs to be repeated a year from now. If there is a question of restrictive disease, a chest x-ray should be done and if questionable, a CT scan of the chest.
Casserly, I. P. et al. 1997. Brit. J. Rheum. 36: 677-682.
Fenlon, H.M. et al. 1997. Am. J. Roentgen. 168: 1067-1072.
Sampaio-Barros, P.D. et al. 2007. Clin. Rheum. 26: 225-230.