{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T20:42:52Z","timestamp":1771879372007,"version":"3.50.1"},"reference-count":62,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2023,10,20]],"date-time":"2023-10-20T00:00:00Z","timestamp":1697760000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["#301967\/2022-9"],"award-info":[{"award-number":["#301967\/2022-9"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004586","name":"Funda\u00e7\u00e3o Carlos Chagas Filho de Amparo \u00e0 Pesquisa do Estado do Rio de Janeiro","doi-asserted-by":"publisher","award":["#E-26\/010.002124\/2019, #E-26\/211.187\/2021, #E-26\/211.104\/2021, and #E-26\/200.929\/2022"],"award-info":[{"award-number":["#E-26\/010.002124\/2019, #E-26\/211.187\/2021, #E-26\/211.104\/2021, and #E-26\/200.929\/2022"]}],"id":[{"id":"10.13039\/501100004586","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","award":["FinanceCode 001, 88881.708719\/2022-01, and 88887.708718\/2022-00"],"award-info":[{"award-number":["FinanceCode 001, 88881.708719\/2022-01, and 88887.708718\/2022-00"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>In rheumatoid arthritis (RA), the involvement of the pulmonary interstitium can lead to structural changes in the small airways and alveoli, leading to reduced airflow and maldistribution of ventilation. The single-breath nitrogen washout (SBN<jats:sub>2<\/jats:sub>W) test is a measure of the ventilatory distribution heterogeneity and evaluates the small airways. This study aimed to find out which clinical, serological, functional and radiological findings are useful to identify RA patients with pathological values of the phase III slope (SIII) measured by the SBN<jats:sub>2<\/jats:sub>W test.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This was a cross-sectional study in which RA patients were assessed using the Health Assessment Questionnaire-Disability Index (HAQ-DI) and the Clinical Disease Activity Index (CDAI) and underwent serological analysis of autoantibodies and inflammatory markers. In addition, they underwent pulmonary function tests (including the SBN<jats:sub>2<\/jats:sub>W test) and chest computed tomography (CT).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of the 60 RA patients evaluated, 39 (65%) had an SIII &gt;120% of the predicted value. There were significant correlations between SIII and age (r = 0.56, p&lt;0.0001), HAQ-DI (r = 0.34, p = 0.008), forced vital capacity (FVC, r = -0.67, p&lt;0.0001), total lung capacity (r = -0.46, p = 0.0002), residual volume\/total lung capacity (TLC) (r = 0.44, p = 0.0004), and diffusing capacity of the lungs for carbon monoxide (r = -0.45, p = 0.0003). On CT scans, the subgroup with moderate\/severe disease had a significantly higher SIII than the normal\/minimal\/mild subgroup (662 (267\u2013970) vs. 152 (88\u2013283)% predicted, p = 0.0004). In the final multiple regression model, FVC, extent of moderate\/severe involvement and age were associated with SIII, explaining 59% of its variability.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In patients with RA, FVC, extent of lung involvement and age, all of which are easily obtained variables in clinical practice, identify poorly distributed ventilation. In addition, the presence of respiratory symptoms and deteriorated physical function are closely related to the distribution of ventilation in these patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0291659","type":"journal-article","created":{"date-parts":[[2023,10,20]],"date-time":"2023-10-20T17:23:42Z","timestamp":1697822622000},"page":"e0291659","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Association between clinical, serological, functional and radiological findings and ventilatory distribution heterogeneity in patients with rheumatoid arthritis"],"prefix":"10.1371","volume":"18","author":[{"given":"Elizabeth Jauhar Cardoso","family":"Bessa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felipe de Miranda Carbonieri","family":"Ribeiro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosana Souza","family":"Rodrigues","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6785-0753","authenticated-orcid":true,"given":"Cl\u00e1udia","family":"Henrique da Costa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rog\u00e9rio","family":"Rufino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geraldo da Rocha Castelar","family":"Pinheiro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8598-4878","authenticated-orcid":true,"given":"Agnaldo Jos\u00e9","family":"Lopes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,10,20]]},"reference":[{"issue":"6","key":"pone.0291659.ref001","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1056\/NEJMra2103726","article-title":"Rheumatoid arthritis: common origins, divergent mechanisms","volume":"388","author":"EM Gravallese","year":"2023","journal-title":"The New England Journal of Medicine"},{"issue":"3","key":"pone.0291659.ref002","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1513\/AnnalsATS.202107-876CME","article-title":"Airway disease in rheumatoid arthritis","volume":"19","author":"SM Matson","year":"2022","journal-title":"Annals of the American Thoracic Society"},{"issue":"2","key":"pone.0291659.ref003","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.rdc.2014.12.004","article-title":"Lung disease in rheumatoid arthritis","volume":"41","author":"ZX Yunt","year":"2015","journal-title":"Rheumatic Diseases Clinics of North America"},{"issue":"11","key":"pone.0291659.ref004","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1016\/j.autrev.2013.05.001","article-title":"Lung involvement in connective tissue diseases: a comprehensive review and a focus on rheumatoid arthritis","volume":"12","author":"B Marigliano","year":"2013","journal-title":"Autoimmunity Reviews"},{"issue":"6","key":"pone.0291659.ref005","doi-asserted-by":"crossref","first-page":"983","DOI":"10.3899\/jrheum.101133","article-title":"Incidence of extraarticular rheumatoid arthritis in Olmsted County, Minnesota, in 1995\u20132007 versus 1985\u20131994: a population-based study","volume":"38","author":"E Myasoedova","year":"2011","journal-title":"J Rheumatol"},{"key":"pone.0291659.ref006","volume-title":"Other titles: Rheumatology (Hochberg) Description","author":"E Myasoedova","year":"2019","edition":"7"},{"key":"pone.0291659.ref007","volume-title":"Firestein & Kelley\u2019s textbook of rheumatology","author":"Bryant R. 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