Rheumatoid arthritis (pulmonary manifestations)
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.
On this page:
Epidemiology
Although RA is more common in women, respiratory disease more commonly develops in men 6.
Clinical presentation
Respiratory symptoms are often absent, or nonspecific 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 RA, 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
- COP - BOOP
- 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
- small centrilobular nodules or tree-in-bud
- rare
- Caplan syndrome
See also
Related Radiopaedia articles
Arthritides
- autoimmune
- degenerative
- depositional
- infectious
- miscellaneous disorders
- related articles
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