Afectación de vías aéreas y pulmón en la artritis reumatoide, síndrome de Sjögren y espondilitis

Immune-mediated rheumatic diseases are a heterogeneous group of conditions which, in addition to joint involvement, are defined by their systemic nature, with the respiratory system being one of the most frequently affected systems. In rheumatoid arthritis (RA), lung injury affects 5% of patients and is a significant cause of mortality. Various structures may be involved, including pleura, lung parenchyma, airway, and vascular involvement. Diffuse interstitial lung disease (DIPD) is the most frequent pulmonary manifestation of RA. In regard to histology, the two predominant types are usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP). Respiratory symptoms such as cough or dyspnea are very frequent in Sjögren's syndrome. The frequency and compromise of pulmonary involvement can manifest in multiple ways involving the airways, lung parenchyma, and pleura. In addition, other forms of pulmonary involvement, including lymphoproliferative diseases such as follicular bronchiolitis and lymphoma, should also be considered in these patients. In spondylitis, it should be considered in cases of advanced disease. Restrictive ventilatory problems may occur when the rib cage joints are affected, resulting in ankylosis; bullous apical pulmonary fibrosis is a characteristic condition. Management of these manifestations requires a multidisciplinary approach to control both the underlying disease and pulmonary complications.