Chest ImagingRheumatoid lung disease
Rheumatoid arthritis (
RA) is commonly associated with
thoracic abnormalities, including
interstitial pneumonitis and
fibrosis,
pleural effusion or
pleural thickening,
necrobiotic nodules,
bronchiolitis obliterans organizing pneumonia (BOOP),
bronchiectasis and
bronchiolitis obliterans. The prevalence of radiologically detectable
interstitial disease in patients with rheumatoid arthritis is probably around 10%. Histologically, radiologically, and on
HRCT, the appearance of
RA with
interstitial fibrosis is usually indistinguishable from that of
idiopathic pulmonary fibrosis (IPF). Clinical evidence of arthritis precedes the development of
pulmonary fibrosis in about 90% of patients, and 90% have a positive serum rheumatoid factor.
HRCT findings reported in patients with rheumatoid arthritis include nodules which are predominantly subpleural in location, bronchial abnormalities and bronchiectasis, ground glass opacity, pulmonary fibrosis with or without honeycombing (Fig.1), consolidation, enlarged lymph nodes and pleural abnormalities. In patients with rheumatoid arthritis, the presence of ground glass opacity, consolidation and fibrosis probably reflects the presence of interstitial pneumonia, while the small and large nodules probably represent necrobiotic nodules. bronchiectasis can be associated with chronic infection, which has an increased incidence in rheumatoid patients, or bronchiolitis obliterans.
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HRCT in a patient with rheumatoid lung disease and fibrosis showing peripheral, subpleural honeycombing.
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Rheumatoid lung disease, Fig.1 | |