Managing Lung Issues in RA: Can Bronchitis-Induced Asthma Be Cured?

Pulmonary issues in rheumatoid arthritis (RA)?

Hello, doctor.
I would like to ask: 1.
Is obstructive bronchiolitis caused by rheumatoid arthritis (RA) curable if mild asthma symptoms begin to appear? (This means: Can medication cure it, and once cured, is there no need for ongoing medication?) 2.
What signs or tests can help confirm that these asthma symptoms are due to RA? Thank you very much.

A Tang, 30~39 year old female. Ask Date: 2014/01/08

Dr. Gao Jiankai reply Internal Medicine

Hello, Tom.
Thank you for your question.
I will address your inquiries in the order they were presented.

1.
There are many types of pulmonary complications caused by rheumatoid arthritis (RA).
If it is obstructive bronchiolitis, the respiratory symptoms are usually more severe and require aggressive treatment.
If the symptoms are only mild asthma-like symptoms, it may not necessarily be obstructive bronchiolitis.
I recommend discussing the exact diagnosis of pulmonary complications with your physician for peace of mind.
In cases of RA with pulmonary complications, treatment typically involves not only the standard RA medications but also adjustments to additional respiratory medications based on the respiratory symptoms.
It is advisable to be mentally prepared for temporary medication to control symptoms for a period of time, and once the symptoms improve, the medication can be simplified.
These matters can also be discussed with your physician.
2.
Distinguishing between pulmonary complications caused by RA and primary lung diseases based solely on examinations can indeed be challenging.
Generally, the likelihood of having both RA and another primary lung disease is lower than having either RA or a primary lung disease alone.
Therefore, unless there are rare pulmonary manifestations that occur in RA, they are typically considered as complications arising from RA.

Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2014/01/08

More Info

Managing lung issues in patients with rheumatoid arthritis (RA) can be quite complex, especially when it comes to conditions like obstructive bronchiolitis and asthma. Let's address your questions one by one.

1. Can Bronchitis-Induced Asthma Be Cured?
When it comes to asthma that is induced by obstructive bronchiolitis related to RA, the term "cure" can be somewhat misleading. While it is possible to manage and control symptoms effectively with medication, the underlying condition—RA—remains chronic. This means that while you may experience periods of remission where symptoms are minimal or absent, the potential for flare-ups exists, particularly if the RA is not well-controlled.

In cases of mild asthma symptoms, treatment typically involves the use of bronchodilators and anti-inflammatory medications, such as corticosteroids. These medications can help alleviate symptoms and improve lung function. However, it is crucial to understand that these treatments may need to be continued long-term to maintain symptom control. Discontinuing medication without medical guidance can lead to a resurgence of symptoms.

In summary, while symptoms can be managed effectively, and patients may experience significant improvement, it is unlikely that one can completely "cure" asthma induced by RA. Ongoing management and regular follow-ups with a healthcare provider are essential to monitor the condition and adjust treatment as necessary.

2. How to Confirm Asthma Symptoms Are Due to RA?
To determine whether asthma symptoms are indeed related to RA-induced obstructive bronchiolitis, several diagnostic approaches can be employed:
- Clinical History and Symptoms: A thorough clinical history is vital. This includes understanding the onset of asthma symptoms in relation to RA diagnosis and treatment. If asthma symptoms began after the onset of RA or during periods of increased disease activity, this may suggest a connection.

- Pulmonary Function Tests (PFTs): These tests measure lung function and can help differentiate between asthma and other lung conditions. A decrease in airflow that improves with bronchodilator use is characteristic of asthma.

- Imaging Studies: Chest X-rays or CT scans can help identify structural changes in the lungs, such as those seen in obstructive bronchiolitis. Ground-glass opacities or other abnormalities may suggest inflammation or damage related to RA.

- Bronchoscopy and Biopsy: In some cases, a bronchoscopy may be performed to directly visualize the airways and obtain tissue samples for histological examination. This can help confirm the presence of inflammatory changes consistent with RA.

- Exclusion of Other Causes: It is also essential to rule out other potential causes of asthma-like symptoms, such as infections, allergies, or other lung diseases. This may involve allergy testing or sputum analysis.

In conclusion, while managing lung issues in RA patients can be challenging, understanding the nature of the symptoms and their relationship to RA is crucial for effective treatment. Regular consultations with healthcare providers, including rheumatologists and pulmonologists, are essential for optimal management of both RA and any associated respiratory conditions.

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