High Resolution Computed Tomography of the Lungs in Patients With Rheumatoid Arthritis and Interstitial Lung Disease

Abstract

We performed high resolution computed tomography (HRCT) on the lungs of 20 patients with RA and clinical and radiological evidence of interstitial lung disease (ILD). A case control group of patients with RA but without evidence of ILD were similarly studied and all patients underwent detailed pulmonary function testing. Clinical findings, drug therapy, smoking status, the presence/absence of SS and disease activity were also assessed. HRCT showed a range of abnormalities among patients thought to have ILD. Interstitial fibrosis was confirmed in 16 but was frequently associated with emphysema. Ground glass opacification was present in seven, while basal honey-combing was also evident in seven patients. Both these features were present in two patients with ILD. Bronchiectasis was identified in six patients and was the predominant finding in two patients previously thought to have ILD. Among the control patients, HRCT was normal in only five. Clinically unsuspected ILD was present in four patients, while a further four had bronchiectasis. Pleural disease was identified in seven controls. Pulmonary function tests were generally poor predictors of HRCT findings, although a reduced residual volume (RV) [> 1 S.D.] was 83% specific for the presence of ILD and a raised RV [> 1 S.D.] was 64% specific for emphysema. Smoking did not correlate with the presence of either ILD or emphysema and there were no correlations between disease activity and HRCT findings. RA patients with evidence of ILD have abnormalities on HRCT which cannot be confidently predicted on any other non-invasive test.(ABSTRACT TRUNCATED AT 250 WORDS)

Pivotal clinical dilemmas in collagen vascular diseases associated with interstitial lung involvement: Table 1—

“…The HRCT findings in RA can be categorised as parenchymal, airways and pleural disease. HRCT is more specific and sensitive for the identification of IP and is abnormal in .80% of patients with RA and suspected IP [26].…”

Coexistence of Bronchiectasis and Rheumatoid Arthritis: Revisited

“…In a study of 20 patients with RA, McDonagh et al documented restrictive spirometry; 4 of the patients had traction BR secondary to pulmonary fibrosis. 36 In the second study, in a group of 20 non-smoking RA patients with no respiratory symptoms, 5 were diagnosed with BR by HRCT. There were no significant differences in spirometry between the patients with RA alone and RA-BR group.…”

“…BR was an independent finding on HRCT requested for patients with suspected RA and interstitial lung disease in 30% of cases. 36 In unselected RA populations the identification of BR on HRCT varied between 17-30.5%, 15,24,36,42,43 with a prevalence of symptomatic BR of 2.9%. 7 There is ethnic variation in the prevalence of BR, as in Chinese patients with RA who underwent HRCT this condition was detected only in 3.64%.…”

Induction of Autoimmune Arthritis after Direct Injection of Bone Marrow Cells from Arthritis-Prone SKG/Jcl Mice into Bone Cavity of Normal Mice

“…They may therefore represent the source of the hypothetically abnormal hematolymphoid cells in RA that produce inflammatory cytokines and attack different organs. 10,11) In contrast, MSCs differentiate into synovial cells and osteoblasts. Potentially abnormal synovial cells can cause synovitis and produce several inflammatory cytokines.…”