Relationship Between Rheumatoid Arthritis Secondary To Interstitial Lung Disease And TCM And Clinical Indicators

Objective:To investigate the pathogenesis and risk factors of Interstitial Lung Disease(ILD) associated with Rheumatoid arthritis(RA) by analyzing the correlation between TCM syndromes, clinic indexes and RA-ILD;To find the most effective diagnostic method of RA-ILD by comparing to the others;in order to guide clinical diagnosis and treatment.Methods:A Retrospective study of279RA patients in the Department of Rheumatology in Guang’ an men hospital of China Academy of Chinese Medical Sciences:according to the diagnostic criteria of TCM syndrome, the patients were sorted to5types:the stagnancy of wind-cold-dampness type,and the stagnancy of heat-dampness type,and the insufficiency of both the liver and the kidney type,and the deficiency of Qi and Blood type,and the stagnancy of sputum-blood type;based on the diagnostic criteria of Western medicine,all the patients were divided into two groups:RA-ILD and non-ILD. To observe the different morbidity of RA-ILD between the syndromes of RA; and to compare clinic date of RA-ILD and non-ILD; and to observe the pulmonary symptoms and signs,and the indexes of RA-ILD.Results:1.The result of observing the different morbidity of RA-ILD between the RA’s syndromes shows:the morbidity of RA-ILD in different syndromes:55.1%of the persons in the deficiency of Qi and Blood type,48.0%of the persons in the insufficiency of both the liver and the kidney type,43.3%of the persons in the stagnancy of sputum-blood type,22.6%of the persons in the stagnancy of heat-dampness type,16.7%of the persons in the stagnancy of wind-cold-dampness type, and there was statistical significance between different syndromes(P<0.05).Doing the deep analysis,there was statistical significance between the deficiency of Qi and Blood type and the stagnancy of heat-dampness type, the stagnancy of wind-cold-dampness type (p<0.05);the insufficiency of both the liver and the kidney type and the stagnancy of heat-dampness type, the stagnancy of wind-cold-dampness type (p<0.05); the stagnancy of sputum-blood type and the stagnancy of heat-dampness type, the stagnancy of wind-cold-dampness type (p<0.05).There were no statistical significances in the deficiency of Qi and Blood type;the insufficiency of both the liver and the kidney type and the stagnancy of sputum-blood type. 2. The result of comparing the clinic date of RA-ILD and non-ILD shows:There was statistical significance in sex structure,age of onset,the rate of smoking,the rate of morning stiffness, the rate of rheumatoid nodule, TJC, ESR, CRP, DAS28, and RF(P<0.05). The number of male, age of onset, the rate of smoking, the rate of morning stiffness, the rate of rheumatoid nodule, TJC, ESR, CRP, DAS28, and RF in RA-ILD is significantly higher than the non-ILD. The other indexes had no statistical significance(P>0.05).3.The morbidity of RA-ILD is34.8%,the number of male is34,female63, male:female=1:1.85.53(54.6%) RA-ILD patients had experienced symptoms and signs, including expectoration53(54.6%), chest distress51(51.6%), shortness of breath31(32.0%), dyspnea22(22.7%),inspiratory crackles11(11.3%), velcro rale5(5.2%).65patients had done the arterial blood gas analysis.66.2%(43) of them had Degression of the oxygen pressure;84.6%(55) had normal pressure of carbon dioxide,12.3%(8) had degression of the pressure,and3.1%(2) had rise of it.80%of RA-ILD patients were found to have abnormal lung functions, including abnormal diffusion function and Normal ventilation function. The manifestations of all the RA-ILD patients’HRCT were abnormal and typical.Conclusion:1.The pathogenesis of RA-ILD is mainly related to the deficiency of Qi and Blood type, the insufficiency of both the liver and the kidney type,and the stagnancy of sputum-blood type;2.High risk of RA-ILD:male, smoking, older age of onset, severe clinical manifestation, inflammatory markers and disease activity are higher.3.To diagnosis RA-ILD,HRCT is much more specific and sensitive than clinical features and pulmonary function test.