This year has been a rough one for me to say the least. I have been hospitalized four times and placed in a nursing home for recovery once. All of that happened in the first six months of the year Finally my doctors and I saw the correlation between my infusions and the onset of pneumonia. Stopping the biologics stopped the infections! This was the 4th failed biologic and second one I reacted to. My Rheumy said that I will not be able to try anymore, my body is telling us that it cannot deal with the biologics, I was very lucky to survive this round and another may kill me. So, good bye biologics for me! RA treatment for me will consist of Pred, MTX, Arava and pain meds. It has been six months since my last infusion, and I can really tell the difference. My inflammation markers are way up, pain levels are rising, morning stiffness runs into mid afternoon.
The biggest health change for me this year though centers on my lungs. Just after New Years I was dxd with RA Lung (Intrinsic Lung Disease) after a chest xray showed masses in my lungs. A follow up Cscan confirmed they were RA masses and not cancerous. Two in my right lung and one in the left. Benign as they may be, they still take up precious room in my lungs and, coupled with the scarring from the chronic pneumonia, teamed up to give me COPD (Chronic Obstructive Pulmonary Disease). Pneumonia as we all know is an infection in the lungs. Lungs of course are a wet, warm place. The kind of place an infection loves to find. There is a Pneumonia vaccine, which I did get and strongly urge you to as well. This vaccine will not cover all infections, however. According to my doctor the best thing we can do is try to keep our lungs dry. When we have back-to-back infections and the scarring to go along with them, my doctor explained that my bronchial tubes, which should be a straight tube, now have pockets in them, sort of bubbles. The mucus in my lungs gets trapped in these bubbles and I cannot clear my lungs. Even with my worse case of pneumonia this year I could cough up nothing. With this info and and my new found knowledge on the biologics, it was easy to see why my pnemonia came back over and over again.
RA lung or Intrinsic Lung Disease can be brought on by many factors. We will focus on auto immune issues here. Of the 1.3 million Americans who have rheumatoid arthritis, nearly half may have some abnormal lung function. Up to one-fourth develop rheumatoid lung disease. In disorders that are intrinsic to the lung, the underlying process is usually pulmonary fibrosis (scarring of the lung). As the disease progresses, the normal lung tissue is gradually replaced by scar tissue interspersed with pockets of air. This can lead to parts of the lung having a honeycomb-like appearance. RA masses in the lungs require constant observation mainly to ensure any growth is not cutting off further lung function.
Causes and classification
Restrictive lung diseases may be due to specific causes which can be intrinsic to the lung, or extrinsic to it.
- Asbestosis caused by long-term exposure to asbestos dust.
- Radiation fibrosis, usually from the radiation given for cancer treatment.
- Certain drugs such as amiodarone, bleomycin and methotrexate.
- As a consequence of another disease such as rheumatoid arthritis.
As you can see, we have plenty of reasons to keep a watch out for RA Lung. I was completely unaware of anything wrong until I recieved the call from my doctor. If you do not currently receive a yearly chest xray, its a good idea to add one to your check list of "to-dos"! When we finally realized what was causing my pneumonia infections, which had grown progressively worse, to the point of respiratory failure on two occasions. I was referred to a pulmonologist. He recieved all of my records and was able to confirm the RA Lung right away. His next words were what struck me though. Mr Carlson, you also have COPD. I have had that word tossed around before, but it was always at arms length, "Your asthma ACTS like COPD" etc. But this was the real deal. No more arms length, no more ignoring it. I HAVE COPD and it will eventually kill me. I felt much the same as I did many years ago when I was told I have RA, but this was more visceral. I didnt know that much about RA, but I had seen plenty about COPD. I was certain there was a mistake. I HAD smoked, but not heavily and I had quit over 20 yrs ago. Nope, no mistake, The prior testing and the one I had in his office that day confirmed it. So how do you know if you have COPD? Sometimes it's not obvious, as the disease can develop slowly. Pay particular attention to these symptoms:
- A cough that doesn't get better
- Multiple respiratory infections
- Shortness of breath made worse by mild activity
- An inability to catch your breath
Sometimes diagnosing rheumatoid arthritis patients with COPD takes awhile because RA patients often are less active than others and are less likely to suffer respiratory distress when they exert themselves physically. If COPD is suspected, however, diagnosing it is often as simple as having the patient blow hard into a small machine that tests lung capacity. This is known as spirometry. A stethoscope may or may not detect lung abnormalities. X-rays and CT scans can aid in diagnosis, but sometimes patients with COPD present normally on these tests. And that is how they confirmed my case, Spirometry is a simple test. You blow into a mouthpiece hooked to a computer that tests both your pressure while blowing out and also in. My test came back with a lung capacity of just 55 percent. I will have further testing in November. Until then, i keep my rescue inhaler handy and have gone back on Spireva as well.
In any case, having a secondary disease along with RA is something most of us are used to. I, myself, after RA developed Reynauds, Fibro, Sjogrens, PsA, Addisons, Diabetes and now COPD. If you have RA and COPD, you'll need to be extra vigilant about your lung health. COPD is not curable, but there are ways to manage it. If you smoke, stop immediately to prevent further lung damage. You also may need an inhaler to open your airways and an anti-inflammatory medication. Oxygen therapy may be required in severe cases. COPD is something you SHOULD speak to your doctor about if you have any concerns. Testing is simple and painless, and it could just save your life!
Brad Additional info from Wikipedia and Quality Health.