Pulmonary manifestations are relatively common in rheumatoid arthritis, and like many of its non-articular manifestations, tend to develop later in the disease.
Although RA is more common in women, respiratory disease more commonly develops in men .
Respiratory symptoms are often absent, or nonspecific such as dyspnea and chronic cough.
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
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
- interstitial fibrosis
- COP - BOOP
- bronchiolitis obliterans
- large rheumatoid nodules
- follicular bronchiolitis
- small centrilobular nodules or tree-in-bud
- Caplan syndrome