Lungs

Dr.Abhishek Zanwar

Rheumatic diseases are a group of autoimmune conditions that affect the joints, connective tissues, and other organs of the body. Autoimmune diseases are conditions in which the immune system mistakenly attacks healthy cells in the body, causing inflammation and damage to various organs and tissues. Some autoimmune diseases can affect the lungs, leading to respiratory symptoms and complications.

The specific ways in which rheumatic diseases affect the lungs can vary depending on the individual disease and its severity. However, some common respiratory symptoms associated with rheumatic diseases include shortness of breath, cough, chest pain, and fatigue. Sometimes medicines given for autoimmune disease can lead to complications like lung infection, which may have similar symptoms. It is important for people with rheumatic diseases to discuss any respiratory symptoms with their healthcare provider, as early diagnosis and treatment can help prevent or manage lung complications.

Rheumatoid arthritis (RA): RA is an autoimmune disease that primarily affects the joints, but can also lead to lung complications. In RA, lung involvement can occur in several ways. One way is through the development of rheumatoid nodules in the lungs, which can lead to inflammation and scarring. Another way is through interstitial lung disease, which is a condition that affects the tissue and space around the air sacs in the lungs. This can cause shortness of breath, coughing, and a decrease in Lung Function.

Systemic lupus erythematosus (SLE): SLE is a systemic autoimmune disease that can affect multiple organs, including the lungs. Lung complications associated with SLE include pleuritis (inflammation of the lining of the lungs), which leads to accumulation of fluids around lungs.

This can cause chest pain and difficulty breathing. SLE can also cause interstitial lung disease and pulmonary artery hypertension. Very rarely SLE can cause serious complication like diffuse alveolar hemorrhage, it happens due to inflammation of small blood vessels of lungs leading to oozing of blood from lungs and hemoptysis. Some SLE patients have tendency to form spontaneous blood clots which may lead to pulmonary embolism ( blood clot gets stuck in an artery in the lung, blocking blood flow to part of the lung)

Scleroderma: Scleroderma is a connective tissue disorder that can cause fibrosis (scarring) of the lungs and skin. It can cause ILD and pulmonary hypertension. Pulmonary arterial hypertension is high blood pressure in the arteries that supply blood to the lungs. This can lead to shortness of breath, fatigue, and swelling in the legs.

Sjogren's syndrome: Sjogren's syndrome is an autoimmune disease that affects the body's moisture-producing glands, such as those in the eyes and mouth. It can also cause inflammation in the lungs, resulting in ILD (Interstitial Lung Disease) .Sometimes it can also cause pleurisy like SLE. 

Polymyositis and dermatomyositis: These are very rare autoimmune diseases that affect the muscles and skin, but can also lead to ILD and interstitial pneumonia. 

Sarcoidosis: Sarcoidosis is a rare autoimmune disease that can cause the formation of granulomas (small clusters of cells) in various organs, including the lungs. Lung involvement in sarcoidosis can cause cough, shortness of breath, chest pain, and fatigue.

Autoimmune vasculitis: Autoimmune vasculitis is a group of autoimmune diseases that affect the blood vessels. When it affects the blood vessels in the lungs, it can cause pulmonary vasculitis, which can lead to shortness of breath, coughing up blood, and chest pain. This can be life threatening and often needs admission to intensive care units.

Idiopathic pneumonia with autoimmune features (IPAF): This is a newly described clinical entity that is characterized by a combination of interstitial lung disease (ILD) and features of autoimmune diseases. The term "idiopathic" is used because the cause of IPAF is unknown, and it is different from other known autoimmune diseases.The diagnosis is usually made with the help of demonstration of autoantibody with ILD. Patients should usually have some rheumatism specific symptoms also. 

Evaluation: X ray or Ultrasound of chest and High resolution CT scan are useful to confirm the lung involvement in autoimmune diseases. Pulmonary function test with diffusion studies can be helpful in assessing disease severity and response to treatment. There are many autoantibodies panel available for diagnosis of specific autoimmune disease and ILD. 

Treatment: It usually need team comprising rheumatologist/immunologist, pulmonologist and rehabilitation team. It is typically focused on controlling inflammation and managing the underlying autoimmune condition. This may involve medications such as corticosteroids, immunosuppressants, and biologics, as well as other measures care like smoking cessation, avoiding exposure to pollutants, and managing other medical conditions like Gastroesophageal reflux disease (GERD) that may exacerbate the ILD. It is important to work closely with your healthcare team to develop a treatment plan that is tailored to your specific needs and goals.Depending on the cause of the ILD, your doctor may prescribe medications to suppress the immune system, reduce inflammation, reduce fibrosis or dilate the airways. Examples of these medications include corticosteroids, immunosuppressants, and anti-fibrotic medicines. If your breathing is impaired, you may need supplemental oxygen to help you breathe more easily. Pulmonary rehabilitation is a program that combines exercise, breathing techniques, and education to help improve lung function and quality of life.