Background/Purpose: Lung involvement in RA it is often diagnosed in advanced stage. Chest CT is the main modality for assessment of ILD. To analyze chest CT changes in a cohort of RA patients followed at our center and their correlation with RA features and prognosis.

Methods: Chest CT scans performed by RA patients were retrospectively analyzed. CT findings were classified as RA-lung and non-RA-lung and correlated to patients data (age, sex, RA duration, smoking, death, DAS28, joint erosions, extra-articular features, CRP, RF, ACPA, FVC, DLCO), and treatment. The search of the MEDLINE was performed using keyword combinations: RA and chest CT; rheumatoid lung and chest CT; RA and ILD  for the period from 1991 until 2015. Statistical analysis included logistic regression. P-value <0.05 was defined as significant.

Results: 48 out of 84 patients (57.2%) had RA-lung. Positive RF (p=0.018), joint erosions (p=0.003) and reduced DLCO (p=0.005) correlated with RA-lung. Treatment with DMARDs had protective effect against RA-lung (p=0.028). Analyzed published literature (100 original articles, reviews and case reports) on chest CT in RA reported on changes in the lung parenchyma, pleura, bronchial system, and the vasculature. CT changes were attributed to RA-lung (mainly ILD) or non-related to RA (new or existing lung pathology, drug induced pneumonitis, and conventional and opportunistic infections, especially in patients treated with synthetic and/or biological DMARDs).

Conclusion: Findings on chest CT attributed to ILD-RA in the literature are variable and difficult for interpretation and classification. Correlation of CT findings with clinical data according to analyzed literature is not fully estimated. There is an unmet need to design an algorithm for prediction of CT changes compatible with ILD-RA with a high probability. Our data indicates that in RA patients with high RF, erosive disease and reduced DLCO there is a high probability for abnormal chest CT study, especially for ILD-RA. Diagnosing of ILD-RA early could allow comprehensive approach to treatment with possible control of both, RA and RA-lung disease; early intervention may change the course of RA and ILD-RA with possible slowing and prevention the progression of ILD-RA toward pulmonary fibrosis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pulmonary-computed-tomography-changes-in-patients-with-rheumatoid-arthritis/