© 1994 British Society for Rheumatology
research-article |
HIGH RESOLUTION COMPUTED TOMOGRAPHY OF THE LUNGS IN PATIENTS WITH RHEUMATOID ARTHRITIS AND INTERSTITIAL LUNG DISEASE
*Departments of Rheumatology, The Royal Victoria Infirmary Newcastle upon Tyne
Departments of Radiology, The Royal Victoria Infirmary Newcastle upon Tyne
Departments of Rheumatology Department, The Queen Elizabeth Hospital Gateshead
Correspondence to:
C. Kelly: Rheumatology Department, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, Tyne and Wear.
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 honeycombing 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. Some degree of abnormality is common even in patients without apparent lung disease. HRCT may offer a useful non-invasive means of assessing RA patients with apparent ILD.
KEY WORDS: Rheumatoid arthritis, Interstitial lung disease, High resolution computed tomography
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