Thoracic Surgical Procedures in Patients with Rheumatoid Arthritis

SEAN M. CAPLES, JAMES P. UTZ, MARK S. ALLEN, and JAY H. RYU

ABSTRACT.

Objective. Rheumatoid arthritis (RA) is associated with a variety of pleuropulmonary manifestations, some of which require surgical intervention. We investigated the spectrum of indications and results, as well as outcome associated with thoracic surgical procedures in rheumatoid patients.

Methods. Identification and retrospective review of medical records of 100 patients with RA at a tertiary-referral medical center undergoing thoracic surgical procedures over a 24-year period from January 1, 1976, to December 31, 1999.

Results. Sixty-four patients underwent surgical lung biopsy for localized lung lesions, 57 of which were nodules or masses; 24 lesions proved to be malignant. Surgical lung biopsy was undertaken in 40 patients for diffuse interstitial lung disease, 4 cases of which were found to be infectious. Five other patients underwent surgery for pleural disease, 3 of which proved to be benign pleuritis.

Conclusion. Patients with rheumatoid disease undergo thoracic surgical procedures for a variety of indications, including benign and malignant localized lesions and pleural disease as well as diffuse parenchymal lung disease. The overall in-hospital mortality rate was low. However, the subgroup with diffuse interstitial lung disease was found to have a 20% in-hospital death rate following surgical lung biopsy. (J Rheumatol 2004;31:2136-41)

Key Indexing Terms:

THORACIC SURGERY
RHEUMATOID ARTHRITIS
LUNG DISEASES
PLEURAL DISEASES

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From the Division of Pulmonary and Critical Care Medicine and Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota, USA.

Supported by Mayo Institutional funds and the Robert N. Brewer Family Foundation.

S.M. Caples, DO; J.P. Utz, MD; J.H. Ryu, MD, Division of Pulmonary and Critical Care Medicine; M.S. Allen, MD, Division of General Thoracic Surgery.

Address reprint requests to Dr. J.H. Ryu, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.

Submitted August 14, 2003; revision accepted May 25, 2004.

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