Pulmonary manifestations in rheumatoid arthritis: high-resolution computed tomography in correlation with the skeletal changes and the laboratory chemical changes

Abstract

It has been the aim of the following study to evaluate pulmonary changes in rheumatoid arthritis with high-resolution CT and to assess their correlation with joint manifestation and laboratory parameters. The authors prospectively performed computed tomography (CT) in 83 patients with rheumatoid arthritis and graded pulmonary changes for frequency and severity. Included were patients with 6-7/7 ARA, BSR > 25/1 min and mean disease duration of 12 years (range, 1-44). Data of medical and drug histories, smoking habits, blood levels of rheumatoid factor (RF), antinuclear antibodies (ANA) and C-reactive protein as well as the degree of joint involvement were taken into account. 58 patients (70%) had pathological CT scans showing the following abnormalities: interlobular thickening (44.5%), intralobular thickening (34%), nonseptal linear attenuation (35%), nodular or linear pleural thickening (32.5%), ground-glass pattern (19%), centrilobular nodules (13%), honeycombing (13%) and bronchiolectasis (9%). Intralobular thickening, honeycombing and pleural thickening were associated with a higher degree of joint manifestation; pleural thickening, honeycombing and ground-glass pattern were associated with a higher level of rheumatoid factor. There was no relationship between pulmonary changes and either the duration of the disease, antinuclear antibodies (ANA) or C-reactive protein. CT may be a useful noninvasive tool for recognition of RA-associated lung disease. Interstitial lung changes are frequent and they are independent of the duration of the disease. Pulmonary interstitial changes are more frequent and more severe in RF-positive patients and in case of more severe joint involvement.