Clinical rheumatology, 1994, 13, N ° 2 239-243 Pericardial and Pulmonary Rheumatoid Arthritis Involvement in in Turkey N. IMERYI~IZ, H. YAZICI, H. KODAK, M. ERK*, A. OZDER**, S.M. KARCIER** M. 0ZKAN***, G. 0NGEN, S. YURDAKUL, H. OZDOGAN Summary Pericardial and lung involvement in rheumatoid arthritis (RA), sus- pected to be less severe in a developing nation (Turkey), have been evaluated. We have studied clinical, echocardiographic and pulmonary findings (radiological and functional) in 93 consecutive Turkish patients with definite/classical RA. Findings were compared with those of a group of patients with osteoarthritis or local rheu- matological conditions (n--60) in a blind protocol. Fifty patients with systemic lupus (SLE) were studied as a high risk control group for pericardial involve- ment. While pericardial disease was detected in 5.5% (5/90) of RA patients, it was detected in 6.6% (4/60) of the control patients. SLE patients had a 26% (13/50) prevalence. Interstitial lung disease was found in 27.7% of RA patients but it was present in 6.6% (4/60) of the control patients. We observed that a group of pa- tients with RA in Turkey had a low prevalence of pericardial disease. This is further evidence that RA has a mild course in developing countries. Key words Rheumatoid Arthritis, l~lmonary, Pericarditis. INTRODUCTION There is evidence that RA has a mild course in de- veloping countries (1-7). In a previous study in our clin- ic, subcutaneous nodules and nail fold vasculitis were found to be less frequent compared to a group of En- glish patients matched for age, sex and disease dura- tion (1). In addition, our informal experience suggest- ed that pericardial and lung disease were also rare among our patients. We therefore investigated in a pro- spective controlled study the frequency of heart and lung involvement in RA. MATERIAL AND METHODS Ninety-three consecutive patients with classical or def- inite rheumatoid arthritis (8) were studied prospective- ly at the time of routine follow-up visits from May 1988 to September 1989 at a rheumatology outpatient clinic in Istanbul, Turkey. From the Divisionof Rheumatology, Department of Medicine, Cer- raphpa~a Medical Faculty, Universityof Istanbul, *Department of Chest Diseases, Cerrahpa~a MedicalFaculty, University of Istanbul, **Haseki Institute of Cardiology,Universityof Istanbul, ***Heart and Research Hospital, Ko§uyolu, Istanbul,Turkey. A control group of 60 consecutive patients with local rheumatological conditions or osteoarthrosis (hereafter referred to as the control group) seen in the same clin- ic were also investigated for pericardial and lung dis- ease. In addition, 50 patients with systemic lupus (SLE) who met ARA revised diagnostic criteria (9), attending the same center, were studied as a high risk control group for pericarditis. All patients were advised about the investigational nature of the study. After a history and a physical examination of each patient, functional class (10) and extraarticular manifestations were not- ed. All RA patients and controls had routine labora- tory tests including complete blood count, urinalysis, erythrocyte sedimentation rate (Westergren), latex ag- glutination test (Behring, Rapitex RF) and CRP mea- surement (Behring Partigen immunodiffusion plates). Cardiological assessment included a chest X-ray, 12 lead EKG and M mode and two dimensional echocardio- graphy. All patients and controls had cardiologic as- sessments. In 3 RA patients the echocardiograms were of poor quality for interpretation. A detailed descrip- tion of the cardiological findings in SLE patients is the subject of another paper (11). The echocardiograms were obtained with a Diasonics DS 20 and Diasonics CV 400 device using 3.5 Mhz transducer and with a General Electric device using 3,3 Mhz phased array transducer. Echoes were recorded with a Mitsubishi Vid-