Rheumatoid arthritis (pulmonary manifestations)
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Pulmonary manifestations are relatively common in rheumatoid arthritis, and like many of its non-articular manifestations, tend to develop later in the disease.
Although rheumatoid arthritis is more common in women, respiratory disease more commonly develops in men 6.
Respiratory symptoms are often absent, or non-specific such as dyspnea and chronic cough.
- bronchocentric granulomatosis: rare 7
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:
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
Chest CT or HRCT features include:
- pleural thickening or effusion
- ground-glass densities 8
- interstitial fibrosis (rheumatoid arthritis associated interstitial lung disease)
- organizing pneumonia
- bronchiolitis obliterans
- large rheumatoid nodules
follicular bronchiolitis: rare
- small centrilobular nodules or tree-in-bud
- Caplan syndrome
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