Background/Purpose: Pulmonary manifestations of rheumatoid arthritis (RA) lead to significant morbidity and mortality. Lung manifestations in RA are myriad, however little is known about how to predict those patients at highest risk for development of clinically significant disease.

Methods: Methods: In this study we performed a screen for lung disease by high resolution computed tomography (HRCT) scan in a population of patients with RA without known interstitial lung disease. We also collected baseline demographics, clinical information and blood was tested for  RA associated antibodies including anti-CCP3 (IgG), CCP3.1 (IgG/IgA), and RF. Chest imaging was reviewed and interpreted by two radiologists with expertise in thoracic radiology who independently reviewed all HRCT scans using a scoring algorithm supplied by the research investigators. For those interpretations which were discriminant between readers, the radiologists discussed the case and came to consensus. We compared demographics (gender, age, duration of RA) and antibody profiles between RA patients with abnormal imaging on HRCT and those who did not have pulmonary disease.

Results: Results: We screened 55 patients from the rheumatology clinic at the University of Colorado, who denied having any lung disease, with HRCT. We found that 31% (n=17) of the patients had findings of pulmonary fibrosis (as defined by abnormal reticulations, evidence of traction bronchiectasis or honeycombing). These 17 patients were determined to have fibrosis in “possible” or “probable” usual interstitial pneumonia (UIP) pattern. We found that those patients with pulmonary fibrosis were older (65.3 vs 54.9 years, p=.007). There was no statistically significant difference in gender, smoking status, duration of RA or antibody profile between those with and without fibrosis. Of the 55 patients scanned, we also found that 62% (n=34) had airways disease as determined by consensus findings of air trapping and bronchial wall thickening without findings of emphysema. In this small cohort, there was no association between presence of airways disease and age, smoking status, duration of RA or antibody positivity.

Conclusion: In this at-risk population for lung disease, we found 31% of RA patients without known lung disease to have findings of pulmonary fibrosis and 62% to have HRCT findings of airways disease. Prospective study of an at risk population for development of lung disease may help inform screening methods.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/findings-of-pulmonary-abnormalities-on-high-resolution-computed-tomography-in-a-cohort-of-rheumatoid-arthritis-patients-without-known-lung-disease/