Predictors of airway and parenchymal lung abnormalities in patients with rheumatoid arthritis

Abstract

Aim of the workTo investigate the frequency and types of pulmonary involvement using high resolution computed tomography (HRCT) and pulmonary function tests (PFTs) and to identify different disease parameters as predictors of lung involvement. Patients and MethodsOne hundred RA patients were recruited from El-Maadi Armed Forces Rheumatology clinic. Spirometry, plain X-ray chest, and HRCT were performed. Disease activity score (DAS28) and Larsen score were assessed. ResultsThey were 77 females and 23 males with a mean age of 55.7 ± 11.4 years and disease duration of 14.9 ± 6.8 years. Extra-articular manifestations included pleura-pulmonary involvement (33%), eye dryness (30%) and skin nodules (13%). PFTs showed abnormalities in 38%. X-ray chest abnormalities were found in 12 patients as follows: pleural effusion (3%), atelectasis in (6%), pulmonary nodules (2%) and hyperinflated chest (3%). Abnormal HRCT findings were found in 68% of the patients: ground glass opacity (GGO) in 36 (52.9%), air trapping in 26 (38.2%), thickened septal/non-septal lines in 21 (30.9%), nodules in 17 (25%), Caplan’s syndrome in 8 (11.8%) and bronchial wall thickening in 8 (11.8%) while 3 (4.4%) showed honey combing and bronchiectasis. Passive smoking, chronic cough, Larsen score and anti-cyclic citrullinated peptide (anti-CCP) titre were significant predictors of lung involvement as detected by HRCT. ConclusionHRCT of the chest was found to be a more sensitive measure than spirometry to diagnose pulmonary abnormalities. Passive smoking, chronic cough, disease severity and high anti-CCP titre were significant independent predictors of lung involvement as detected by PFT and HRCT among rheumatoid patients.