Pulmonary manifestations are relatively common in rheumatoid arthritis, and like many of its non-articular manifestations, tend to develop later in the disease.
Please refer to the related articles for a general discussion of rheumatoid arthritis, and for the specific discussion of its musculoskeletal manifestations.
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Epidemiology
Although rheumatoid arthritis is more common in women, respiratory disease more commonly develops in men 6.
Clinical presentation
Respiratory symptoms are often absent, or non-specific such as dyspnea and chronic cough.
Pathology
Associations
- bronchocentric granulomatosis: rare 7
Radiographic features
Patterns of lung involvement include interstitial, airway and pleural disease.
Pleural involvement is a common manifestation of rheumatoid arthritis, although usually asymptomatic.
- pleural thickening: is seen more commonly than pleural effusions
- pleural effusions: occur late in the disease, are often unilateral and associated with pericarditis and subcutaneous nodules 5
Other manifestations include:
Plain radiograph
Chest radiograph may show:
- pleural effusion
- lower zone predominant reticular or reticulonodular pattern
- volume loss in advanced disease
- skeletal changes, e.g. erosion of clavicles, glenohumeral erosive arthropathy, superior rib notching
CT
Chest CT or HRCT features include:
- pleural thickening or effusion
- ground-glass densities 8
- interstitial fibrosis (rheumatoid arthritis associated interstitial lung disease)
- organizing pneumonia
- bronchiectasis
- bronchiolitis obliterans
- large rheumatoid nodules
- single or multiple
- tend to be based peripherally
- may cavitate (necrobiotic lung nodules)
- cavitation of a peripheral nodule can lead to pneumothorax or hemopneumothorax
-
follicular bronchiolitis: rare
- small centrilobular nodules or tree-in-bud
- Caplan syndrome