Generic placeholder image

Current Respiratory Medicine Reviews


ISSN (Print): 1573-398X
ISSN (Online): 1875-6387

Review Article

The Spectrum of Airway Disease Associated with Rheumatoid Arthritis

Author(s): Salieva Rana Sherbaevna, Mamasaidov Abdumitalib Tashalievich, Azhimamatova Rakhima Momunovna, Salhah Hamed Alrefaee, Musaeva Begaiym Sovetbekovna, Mamatova Sabirakhan Mirzaevna and Mohd Faizan Siddiqui*

Volume 18, Issue 3, 2022

Published on: 21 July, 2022

Page: [179 - 189] Pages: 11

DOI: 10.2174/1573398X18666220509153713

Price: $65


Airway involvement results from long-standing rheumatoid arthritis leading to severe pulmonary complications, correlated with increased mortality and socioeconomic costs. Different types of pulmonary lesions, including pulmonary rheumatoid nodule, pulmonary arteritis, diffuse interstitial fibrosis, and rheumatoid pneumoconiosis or Caplan's syndrome, are believed to be related to rheumatoid arthritis (R.A.). The above changes may indicate the increased susceptibility to the infection, toxins from a disease, or chronic immunity activation. The symptoms vary from asymptomatic to severe life-treating conditions, and the prognosis varies depending on the genre and severity of involvement. Our study aims to assess the prevalence and characteristics of airways association in rheumatoid arthritis as these data provide a brief insight into early diagnosis and treatment, which could be applied to minimize complications of airways diseases in rheumatoid arthritis.

Keywords: Rheumatoid arthritis, upper airway disease, lower airway disease, pulmonary involvement, obstruction, pulmonary dysfunction.

Zayeni H, Haji-Abbasi A, Foumani SA, et al. Pulmonary involvement in rheumatoid arthritis: A cross-sectional study in Iran. Lung India 2016; 33(1): 49-52.
[] [PMID: 26933307]
Koduri G, Norton S, Young A, et al. ERAS (Early Rheumatoid Arthritis Study). Interstitial lung disease has a poor prognosis in rheuma-toid arthritis: Results from an inception cohort. Rheumatology (Oxford) 2010; 49(8): 1483-9.
[] [PMID: 20223814]
Ellman P, Ball RE. Rheumatoid disease with joint and pulmonary manifestations. BMJ 1948; 2(4583): 816-20.
[] [PMID: 18890308]
(a) Caplan A. Certain unusual radiological appearances in the chest of coal-miners suffering from rheumatoid arthritis. Thorax 1953; 8(1): 29-37.; (b) Hopkinson NS, Kemp SV, Toma TP, et al. Atelectasis and survival after bronchoscopic lung volume reduction for COPD. Eur Respir J 2011; 37(6): 1346-51.
[] [PMID: 20947683]
Figus FA, Piga M, Azzolin I, McConnell R, Iagnocco A. Rheumatoid arthritis: Extra-articular manifestations and comorbidities. Autoimmun Rev 2021; 20(4): 102776.
[] [PMID: 33609792]
Jurik AG, Pedersen U. Rheumatoid arthritis of the crico-arytenoid and crico-thyroid joints: A radiological and clinical study. Clin Radiol 1984; 35(3): 233-6.
[] [PMID: 6713800]
Alunno A, Gerli R, Giacomelli R, Carubbi F. Clinical, epidemiological, and histopathological features of respiratory involvement in rheu-matoid arthritis. BioMed Res Int 2017; 2017: 7915340.
[] [PMID: 29238722]
Devouassoux G, Cottin V, Lioté H, et al. Groupe d’Etudes et de Recherche sur les Maladies “Orphelines” Pulmonaires (GERM“O”P). Characterisation of severe obliterative bronchiolitis in rheumatoid arthritis. Eur Respir J 2009; 33(5): 1053-61.
[] [PMID: 19129282]
Geddes DM, Webley M, Emerson PA. Airways obstruction in rheumatoid arthritis. Ann Rheum Dis 1979; 38(3): 222-5.
[] [PMID: 485577]
Zohal MA, Yazdi Z, Ghaemi AR, Abbasi M. Small airways involvement in patients with rheumatoid arthritis. Glob J Health Sci 2012; 5(2): 166-70.
[] [PMID: 23445704]
(a) Urisman A, Jones KD. Pulmonary pathology in connective tissue disease. Semin Respir Crit Care Med 2014; 35(2): 201-12.
[] [PMID: 24668535] ; (b) Doran M, Crowson C, Pond G, et al. Predictors of infection in rheumatoid arthritis. Arth Rheumatol 2002; 46(9): 2294-300.
[PMID: 12355476]
Benner A, Sharma P, Sharma S. Anatomy, head and neck, cervical, respiratory, larynx, and cricoarytenoid. In: StatPearls. Treasure Island, FL: StatPearls Publishing 2022.
Maeso-Plaza AM, Salgado FJM, Aristegui I. Acute airway obstruction in rheumatoid arthritis. Otolaryngology 2016; 6: 282.
Shaw M, Collins BF, Ho LA, Raghu G. Rheumatoid arthritis-associated lung disease. Eur Respir Rev 2015; 24(135): 1-16.
[] [PMID: 25726549]
Kolman J, Morris I. Cricoarytenoid arthritis: A cause of acute upper airway obstruction in rheumatoid arthritis. Can J Anaesth 2002; 49(7): 729-32.
[] [PMID: 12193494]
Peters JE, Burke CJ, Morris VH. Three cases of rheumatoid arthritis with laryngeal stridor. Clin Rheumatol 2011; 30(5): 723-7.
[] [PMID: 21213004]
Bamshad M, Rosa U, Padda G, Luce M. Acute upper airway obstruction in rheumatoid arthritis of the cricoarytenoid joints. South Med J 1989; 82(4): 507-11.
[] [PMID: 2705077]
Masilamani K, Gandhi A. Cricoarytenoid arthritis presenting as croup. J R Soc Med 2009; 102(11): 491-2.
[] [PMID: 19875539]
Hamdan A-L, El-Khatib M, Dagher W, Othman I. Laryngeal involvement in rheumatoid arthritis. Middle East J Anaesthesiol 2007; 19(2): 335-44.
[PMID: 17684874]
Gómez-Puerta JA, Cisternas A, Hernández MV, Ruiz-Esquide V, Vilaseca I, Sanmartí R. Valoración laríngea mediante videolaringoestro-boscopia en pacientes con artritis reumatoide. Reumatol Clin 2014; 10(1): 32-6.
[] [PMID: 23830735]
Lawry GV, Finerman ML, Hanafee WN, Mancuso AA, Fan PT, Bluestone R. Laryngeal involvement in rheumatoid arthritis. A clinical, laryngoscopic, and computerized tomographic study. Arthritis Rheum 1984; 27(8): 873-82.
[] [PMID: 6466395]
Woldorf NM, Pastore PN, Terz J. Rheumatoid arthritis of the cricoarytenoid joint. Arch Otolaryngol 1971; 93(6): 623-7.
[] [PMID: 5556025]
Miller RD, Hyatt RE. Evaluation of obstructing lesions of the trachea and larynx by flow-volume loops. Am Rev Respir Dis 1973; 108(3): 475-81.
[] [PMID: 4745245]
Anzueto A, Levine SM, Tillis WP, Calhoon JH, Bryan CL. Use of the flow-volume loop in the diagnosis of bronchial stenosis after single lung transplantation. Chest 1994; 105(3): 934-6.
[] [PMID: 7510602]
Modrykamien AM, Gudavalli R, McCarthy K, Liu X, Stoller JK. Detection of upper airway obstruction with spirometry results and the flow-volume loop: A comparison of quantitative and visual inspection criteria. Respir Care 2009; 54(4): 474-9.
[PMID: 19327182]
Nouraei SAR, Nouraei SM, Patel A, et al. Diagnosis of laryngotracheal stenosis from routine pulmonary physiology using the expiratory disproportion index. Laryngoscope 2013; 123(12): 3099-104.
[] [PMID: 23686716]
France JE, Thomas MJ. Clinical use of the Empey index in the emergency department. Emerg Med J 2004; 21(5): 642-3.
[] [PMID: 15333560]
Brake MK, Anderson J. Bilateral vocal fold immobility: A 13 year review of etiologies, management and the utility of the Empey index. J Otolaryngol Head Neck Surg 2015; 44(1): 27.
[] [PMID: 26111526]
Ding Q, Luckhardt T, Hecker L, et al. New insights into the pathogenesis and treatment of idiopathic pulmonary fibrosis. Drugs 2011; 71(8): 981-1001.
[] [PMID: 21668038]
Chanda D, Otoupalova E, Smith SR, Volckaert T, De Langhe SP, Thannickal VJ. Developmental pathways in the pathogenesis of lung fibrosis. Mol Aspects Med 2019; 65: 56-69.
[] [PMID: 30130563]
Barnes PJ. Cellular and molecular mechanisms of asthma and COPD. Clin Sci Lond Engl 2017; 131(13): 1541-58.
(a) Panjwani A, Lodha J. Pulmonary function test in upper airway obstruction: A simple yet effective diagnostic test. Egypt J Intern Med 2019; 31(2): 243-6.
[] ; (b) Seo HW, Choi HW, Bang SS, Tae K. A case of rheumatoid nodules involving the larynx. Korean J Otorhinolaryngol-Head Neck Surg 2019; 62(11): 663-6.
Ozkaya S, Bilgin S, Hamsici S, Findik S. The pulmonary radiologic findings of rheumatoid arthritis. Respir Med CME 2011; 4(4): 187-92.
Sutherland ER, Martin RJ. Airway inflammation in chronic obstructive pulmonary disease: Comparisons with asthma. J Allergy Clin Immunol 2003; 112(5): 819-27.
[] [PMID: 14610463]
Barnes PJ. Inflammatory mechanisms in patients with chronic obstructive pulmonary disease. J Allergy Clin Immunol 2016; 138(1): 16-27.
[] [PMID: 27373322]
Leru PM. Biomarkers in asthma - interpretation, and utility in current asthma management. Curr Respir Med Rev 2021; 17(2): 62-8.
Betancourt-Peña J, Benavides-Córdoba V, Avila-Valencia JC, Rosero-Carvajal HE. Differences between COPD patients of a pulmonary rehabilitation program according to the mMRC dyspnea scale. Curr Respir Med Rev 2019; 15(1): 32-8.
(a) Grossman A, Martin JR, Root HS. Rheumatoid arthritis of the crico-arytenoid joint. Laryngoscope 1961; 71(5): 530-44.
[] ; (b) Hamdan AL, Sarieddine D. Laryngeal manifestations of rheuma-toid arthritis. Autoimmune Dis 2013; 2013: 103081.
[] [PMID: 23864939]
Rudrappa M, Kokatnur L, Shah S. Case report: Upper airway obstruction due to rheumatoid arthritis. F1000 Res 2020; 9: 119.
[] [PMID: 34484694]
Bienenstock H, Ehrlich GE, Freyberg RH. Rheumatoid arthritis of the cricoarytenoid joint: A clinicopathologic study. Arthritis Rheum 1963; 6(1): 48-63.
[] [PMID: 13968175]
Hassan WU, Keaney NP, Holland CD, Kelly CA. Bronchial reactivity and airflow obstruction in rheumatoid arthritis. Ann Rheum Dis 1994; 53(8): 511-4.
[] [PMID: 7944635]
Stojanovic S, Belic B. Laryngeal Manifestations of Rheumatoid Arthritis. Innovative Rheumatology. InTech 2013.
Wilczynska MM, Condliffe AM, McKeon DJ. Coexistence of bronchiectasis and rheumatoid arthritis: Revisited. Respir Care 2013; 58(4): 694-701.
[] [PMID: 22782500]
Webb J, Payne WH. Rheumatoid nodules of the vocal folds. Ann Rheum Dis 1972; 31(2): 122-5.
[] [PMID: 4111640]
Pradhan P, Bhardwaj A, Venkatachalam VP. Bilateral cricoarytenoid arthritis: A cause of recurrent upper airway obstruction in rheumatoid arthritis. Malays J Med Sci 2016; 23(3): 89-91.
[PMID: 27418875]
Cobb S, Anderson F, Bauer W. Length of life and cause of death in rheumatoid arthritis. N Engl J Med 1953; 249(14): 553-6.
[] [PMID: 13087647]
Pasteur MC, Bilton D, Hill AT. British thoracic society bronchiectasis guideline group. british thoracic society guideline for non-cfbronchiectasis. Thorax 2010; 65(Suppl. 1): i1-i58.
Kamanli A, Gok U, Sahin S, Kaygusuz I, Ardicoglu O, Yalcin S. Bilateral cricoarytenoid joint involvement in rheumatoid arthritis. A case report Rheumatology 2001; 40(5): 593-4.
[] [PMID: 11371675]
Geterud A, Ejnell H, Månsson I, Sandberg N, Bake B, Bjelle A. Severe airway obstruction caused by laryngeal rheumatoid arthritis. J Rheumatol 1986; 13(5): 948-51.
[PMID: 3820205]
McGeehan DF, Crinnion JN, Strachan DR. Life-threatening stridor presenting in a patient with rheumatoid involvement of the larynx. Arch Emerg Med 1989; 6(4): 274-6.
[] [PMID: 2610804]
Montgomery WW, Goodman ML. Rheumatoid cricoarytenoid arthritis complicated by upper esophageal ulcerations. Ann Otol Rhinol Laryngol 1980; 89(1 Pt 1): 6-8.
[] [PMID: 7356266]
Murano E, Hosako-Naito Y, Tayama N, et al. Bamboo node: Primary vocal fold lesion as evidence of autoimmune disease. J Voice 2001; 15(3): 441-50.
[] [PMID: 11575639]
Foo SY, Phipps S. Regulation of inducible BALT formation and contribution to immunity and pathology. Mucosal Immunol 2010; 3(6): 537-44.
[] [PMID: 20811344]
Perez T, Remy-Jardin M, Cortet B. Airways involvement in rheumatoid arthritis: Clinical, functional, and HRCT findings. Am J Respir Crit Care Med 1998; 157(5 Pt 1): 1658-65.
Demoruelle MK, Solomon JJ, Fischer A, Deane KD. The lung may play a role in the pathogenesis of rheumatoid arthritis. Int J Clin Rheumatol 2014; 9(3): 295-309.
[] [PMID: 26089988]
Rabe KF, Hurd S, Anzueto A, et al. Global initiative for chronic obstructive lung disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007; 176(6): 532-55.
[] [PMID: 17507545]
Cortet B, Perez T, Roux N, et al. Pulmonary function tests and high resolution computed tomography of the lungs in patients with rheuma-toid arthritis. Ann Rheum Dis 1997; 56(10): 596-600.
[] [PMID: 9389220]
Chung MH, Lee HG, Kwon SS, et al. Airway obstruction in rheumatoid arthritis: CT manifestations, correlated with pulmonary function testing. Yonsei Med J 2004; 45(3): 443-52.
[] [PMID: 15227731]
Gelb AF, Williams AJ, Zamel N. Spirometry. FEV1 vs FEF25-75 percent. Chest 1983; 84(4): 473-4.
[] [PMID: 6617285]
Geddes DM, Corrin B, Brewerton DA, Davies RJ, Turner-Warwick M. Progressive airway obliteration in adults and its association with rheumatoid disease. Q J Med 1977; 46(184): 427-44.
[PMID: 594297]
Tanaka N, Kim JS, Newell JD, et al. Rheumatoid arthritis-related lung diseases: CT findings. Radiology 2004; 232(1): 81-91.
[] [PMID: 15166329]
Sidhu HS, Bhatnagar G, Bhogal P, Riordan R. Imaging features of the pleuropulmonary manifestations of rheumatoid arthritis: Pearls and pitfalls. J Clin Imaging Sci 2011; 1: 32.
[] [PMID: 21966629]
Shen T-C, Lin CL, Chen CH, et al. Increased risk of chronic obstructive pulmonary disease in patients with rheumatoid arthritis: A popu-lation-based cohort study. QJM 2014; 107(7): 537-43.
[] [PMID: 24497528]
Vergnenègre A, Pugnere N, Antonini MT, et al. Airway obstruction and rheumatoid arthritis. Eur Respir J 1997; 10(5): 1072-8.
[] [PMID: 9163649]
Penny WJ, Knight RK, Rees AM, Thomas AL, Smith AP. Obliterative bronchiolitis in rheumatoid arthritis. Ann Rheum Dis 1982; 41(5): 469-72.
[] [PMID: 7125715]
Krishna R, Anjum F, Oliver TI. Bronchiolitis Obliterans. In: StatPearls. Treasure Island, FL: StatPearls Publishing 2022.
Jerkic S-P, Brinkmann F, Calder A, et al. Postinfectious bronchiolitis obliterans in children: Diagnostic workup and therapeutic options: A workshop report. Can Respir J 2020; 2020: 5852827.
[] [PMID: 32076469]
Obeidat N, AlRyalat SA, Al Oweidat K, et al. Long-term effects of gastric bypass surgery in patients with obstructive sleep apnea. Curr Respir Med Rev 2020; 16(1): 34-8.
Lynch JP III, Weigt SS, DerHovanessian A, Fishbein MC, Gutierrez A, Belperio JA. Obliterative (constrictive) bronchiolitis. Semin Respir Crit Care Med 2012; 33(5): 509-32.
[] [PMID: 23001805]
Bergeron A, Godet C, Chevret S, et al. Bronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: Phenotypes and prognosis. Bone Marrow Transplant 2013; 48(6): 819-24.
[] [PMID: 23208317]
Ryu JH, Azadeh N, Samhouri B, Yi E. Recent advances in the understanding of bronchiolitis in adults. F1000 Res 2020; 9: F1000.
Cheng G-S, Storer B, Chien JW, et al. Lung function trajectory in bronchiolitis obliterans syndrome after allogeneic hematopoietic cell transplant. Ann Am Thorac Soc 2016; 13(11): 1932-9.
[] [PMID: 27513368]
Parimon T, Yao C, Stripp BR, Noble PW, Chen P. Alveolar epithelial type II cells as drivers of lung fibrosis in idiopathic pulmonary fibro-sis. Int J Mol Sci 2020; 21(7): E2269.
[] [PMID: 32218238]
Schruf E, Schroeder V, Le HQ, et al. Recapitulating idiopathic pulmonary fibrosis related alveolar epithelial dysfunction in a human iPSC-derived air-liquid interface model. FASEB J 2020; 34(6): 7825-46.
[] [PMID: 32297676]
Ota C, Ng-Blichfeldt JP, Korfei M, et al. Dynamic expression of HOPX in alveolar epithelial cells reflects injury and repair during the pro-gression of pulmonary fibrosis. Sci Rep 2018; 8(1): 12983.
[] [PMID: 30154568]
Garg D, Mody M, Pal C, et al. Follicular bronchiolitis: Two cases with varying clinical and radiological presentation. Case Rep Pulmonol 2020; 2020: 4564587.
[] [PMID: 32047693]
Dai J, Cai HR, Li Y, Meng FQ, Wu JQ. [Follicular bronchiolitis: Report of 3 cases and literature review] Zhonghua Jie He He Hu Xi Za Zhi 2017; 40(6): 457-62.
[] [PMID: 28592030]
Licari A, Castagnoli R, Tondina E, et al. Novel biologics for the treatment of pediatric severe asthma. Curr Respir Med Rev 2020; 15(3): 195-204.
Sgalla G, Iovene B, Calvello M, Ori M, Varone F, Richeldi L. Idiopathic pulmonary fibrosis: Pathogenesis and management. Respir Res 2018; 19(1): 32.
[] [PMID: 29471816]
Fraser E, Hoyles RK. Therapeutic advances in idiopathic pulmonary fibrosis. Clin Med (Lond) 2016; 16(1): 42-51.
[] [PMID: 26833513]
Funke M, Geiser T. Idiopathic pulmonary fibrosis: The turning point is now! Swiss Med Wkly 2015; 145: w14139.
[] [PMID: 26024356]
Kolb M, Bonella F, Wollin L. Therapeutic targets in idiopathic pulmonary fibrosis. Respir Med 2017; 131: 49-57.
[] [PMID: 28947042]
Graney BA, Fischer A. Interstitial pneumonia with autoimmune features. Ann Am Thorac Soc 2019; 16(5): 525-33.
[] [PMID: 30695649]
Raghu G. Idiopathic pulmonary fibrosis: Lessons from clinical trials over the past 25 years. Eur Respir J 2017; 50(4): 1701209.
[] [PMID: 29074545]
Raghu G, Anstrom KJ, King TE Jr, Lasky JA, Martinez FJ. Idiopathic pulmonary fibrosis clinical research network. Prednisone, azathio-prine, and N-acetylcysteine for pulmonary fibrosis. N Engl J Med 2012; 366(21): 1968-77.
[] [PMID: 22607134]
Fischer A, Antoniou KM, Brown KK, et al. “ERS/ATS task force on undifferentiated forms of CTD-ILD”. An official European respirato-ry Society/American thoracic society research statement: Interstitial pneumonia with autoimmune features. Eur Respir J 2015; 46(4): 976-87.
[] [PMID: 26160873]
Chernau AK, Leone PM, Swigris JJ. Interstitial pneumonia with autoimmune features and undifferentiated connective tissue disease. Semin Respir Crit Care Med 2019; 40(2): 271-7.
[] [PMID: 31137065]
Nishiyama O, Tohda Y. Interstitial pneumonia with autoimmune features. Nihon Rinsho Meneki Gakkai Kaishi 2017; 40(3): 139-44.
[] [PMID: 28747599]
Kelly BT, Moua T. Overlap of interstitial pneumonia with autoimmune features with undifferentiated connective tissue disease and contri-bution of UIP to mortality. Respirology 2018; 23(6): 600-5.
[] [PMID: 29320807]
King PT. The pathophysiology of bronchiectasis. Int J Chron Obstruct Pulmon Dis 2009; 4: 411-9.
[] [PMID: 20037680]
Shadick NA, Fanta CH, Weinblatt ME, O’Donnell W, Coblyn JS. Bronchiectasis. A late feature of severe rheumatoid arthritis. Medicine (Baltimore) 1994; 73(3): 161-70.
[] [PMID: 8190039]
Demoruelle MK, Weisman MH, Simonian PL, et al. Brief report: Airways abnormalities and rheumatoid arthritis-related autoantibodies in subjects without arthritis: Early injury or initiating site of autoimmunity? Arthritis Rheum 2012; 64(6): 1756-61.
[] [PMID: 22183986]
Attar SM, Alamoudi OS, Aldabbag AA. Prevalence and risk factors of asymptomatic bronchiectasis in patients with rheumatoid arthritis at a tertiary care center in Saudi Arabia. Ann Thorac Med 2015; 10(3): 176-80.
[] [PMID: 26229559]
Perry E, Stenton C, Kelly C, Eggleton P, Hutchinson D, De Soyza A. RA autoantibodies as predictors of rheumatoid arthritis in non-cystic fibrosis bronchiectasis patients. Eur Respir J 2014; 44(4): 1082-5.
[] [PMID: 24969651]
Geri G, Dadoun S, Bui T, et al. Risk of infections in bronchiectasis during disease-modifying treatment and biologics for rheumatic dis-eases. BMC Infect Dis 2011; 11(1): 304.
[] [PMID: 22046967]
Musameh K, Campbell CD, Rutherford RM. Marked deterioration in rheumatoid arthritis associated bronchiectasis following treatment with Rituximab. Respir Med Case Rep 2019; 28: 100904.
[] [PMID: 31360633]
Polisar IA, Burbank B, Levitt LM, Katz HM, Morrione TG. Bilateral midline fixation of cricoarytenoid joints as a serious medical emer-gency. J Am Med Assoc 1960; 172(9): 901-6.
[] [PMID: 14433805]
Todic J, Schweizer V, Leuchter I. Bamboo nodes of vocal folds: A description of 10 cases and review of the literature. Folia Phoniatr Logop 2018; 70(1): 1-7.
[] [PMID: 29847817]
Habib MA. Intra-articular steroid injection in acute rheumatoid arthritis of the larynx. J Laryngol Otol 1977; 91(10): 909-10.
[] [PMID: 925498]
Keenan MA, Stiles CM, Kaufman RL. Acquired laryngeal deviation associated with cervical spine disease in erosive polyarticular arthritis. Use of the fiberoptic bronchoscope in rheumatoid disease. Anesthesiology 1983; 58(5): 441-9.
[] [PMID: 6837996]
Vidnes J, Sovik O. Gluconeogenesis in infancy and childhood. III. Deficiency of the extramitochondrial form of hepatic phosphoenolpy-ruvate carboxykinase in a case of persistent neonatal hypoglycaemia. Acta Paediatr Scand 1976; 65(3): 307-12.
[] [PMID: 179269]

Rights & Permissions Print Export Cite as
© 2022 Bentham Science Publishers | Privacy Policy