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Pulmonary Hypertension

Rheumatoid arthritis and PH

04/17/2008

Question:

I had my first appointment with my cardiologist today and she told me that my PH was caused by my RA. The pressure is not that high but they have to keep a check on it. If my RA goes into remission or gets better then it is now could the PH be cured?

Answer:

Thank you for your question. Pulmonary hypertension without other lung disease is relatively uncommon in patients with rheumatoid arthritis. Other forms of lung disease such as pulmonary fibrosis (scarring of the lungs) and pleural effusions (fluid outside the lung) are much more common in rheumatoid arthritis. Additionally, some patients with pulmonary fibrosis will develop a degree of pulmonary hypertension as a result of the lung destruction and possibly a low oxygen level.

Before giving you a diagnosis of pulmonary hypertension from rheumatoid arthritis, I would ensure that you do not have any of the other causes of PH and I would perform a right heart catheterization (pulmonary artery catheterization). Little is known about isolated pulmonary hypertension with rheumatoid arthritis. It is generally thought to be mild disease which does not progress to severe disease although the collective medical experience is small.

There is at least one case report of pulmonary hypertension from rheumatoid arthritis improving with treatment of the RA (and improvement in the RA symptoms), However, I would interpret this with great caution. Again, I would emphasize the need to exclude other known causes of pulmonary hypertension and confirmation of the diagnosis with a right heart catheterization if this has not already been performed.

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Response by:

Douglas W Haden, MD Douglas W Haden, MD
Assistant Professor
College of Medicine
The Ohio State University

Namita   Sood, MD, FCCP Namita Sood, MD, FCCP
Associate Professor of Pulmonary, Critical Care & Sleep
College of Medicine
The Ohio State University