The role of HRCT in evaluation of thoracic manifestations of rheumatoid arthritis

Background: Pulmonary involvement is frequent and among the most severe extra-articular manifestations of rheumatoid arthritis (RA) ranking as the second cause of mortality in this patient population. RA can affect lung parenchyma, airways and pleura. HRCT is currently the imaging modality of choice in diagnosis of thoracic manifestations of RA being superior to chest radiography in demonstrating the presence and extent of lung abnormalities. Aim of work: Evaluate the HRCT findings in patients with pulmonary complications of RA. Patients and methods: This study involved 20 patients; 14 females and 6 males, age range 16–64 years (average 48 years). All patients were known cases of RA presenting with dyspnea and cough. Pulmonary complications associated with RA have been evaluated through: clinical examination; laboratory tests mostly CBC and other tests were considered according to case e.g., sputum analysis etc.; and radiological (chest radiograph and HRCT) and functional (Spirometry) assessment. Results: HRCT findings showed signs of interstitial disease in 9 cases (45%), air-way disease in 9 cases (45%) and findings of both entities in 2 cases (10%). 11 cases showed HRCT signs of ILD as follows: 10 (91%) cases showed bilateral subpleural predominantly basal GGO, 8 (73%) cases showed bilateral subpleural predominantly basal reticulation with traction bronchiolectasis, 1 (9%) case showed diffuse GGO, and 2 (18%) cases showed cysts. Out of 11 cases, 9 (89%) cases were consistent with NSIP and 2 (11%) cases were consistent with LIP. 11 cases showed HRCT signs of airway disease, 10 (91%) cases showed bronchial wall thickening, 9 (82%) cases showed hyperinflation, 6 (55%) cases showed bronchiectasis, 5 (45%) cases showed mosaic perfusion, 3 (27%) cases showed beading of the bronchial wall, and 1 (9%) case showed air trapping. PFT showed restrictive changes in 6 out of the 9 patients with HRCT findings of ILD, obstructive changes with signs of small airway disease in 8 out of the 9 patients with HRCT findings suggestive of airway disease, and mixed restrictive and obstructive findings in the 2 patients with both entities by HRCT. Conclusion: Role of HRCT imaging in the evaluation and diagnosis of patients with intra-thoracic manifestations of RA is central, being accurate and non-invasive