Rheumatoid arthritis (pulmonary manifestations)
Clinical and
radiological features of lung disorders related to connective-tissue diseases: a pictorial essay. Axial (A, B) and sagittal (C) HRCT images of a UIP pattern in a 72-year-old patient with rheumatoid arthritis. The images show the typical UIP pattern, predominantly located on basal and subpleural regions, and represented by honeycombing areas (black arrows in A–C), reticulations (white arrows in A, B) and traction bronchiectasis (white empty arrow in B)
Clinical and
radiological features of lung disorders related to connective-tissue diseases: a pictorial essay. Axial HRCT images of a patient with rheumatoid arthritis. A, B clearly show ground-glass opacities (empty white arrows) and bronchiectasis (white arrows), resembling an NSIP pattern
Clinical and
radiological features of lung disorders related to connective-tissue diseases: a pictorial essay. Axial HRCT images of an NSIP pattern in a patient with rheumatoid arthritis. A, B Ground-glass opacities (empty white arrows) can be appreciated through the pulmonary parenchyma. The heterogeneous distribution of ground glass regions reflects areas of inflammation—alternated to normal lung regions
Clinical and
radiological features of lung disorders related to connective-tissue diseases: a pictorial essay. Anterior upper lobe sign in a patient with RA. It consists of a particular fibrosis distribution, most concentrated along the anterior side of the upper lobes; it can be appreciated on axial (black arrows in A, B) and sagittal MPR image (black arrow in C)
Clinical and
radiological features of lung disorders related to connective-tissue diseases: a pictorial essay. Axial (A, C), coronal (B) and sagittal (D) HRCT images demonstrate—in an RA patient—the presence of a florid honeycombing, involving more than 50% of the lung. This finding is typically due to macrocystic spaces (white arrows) and has been defined as “exuberant honeycombing sign”
Clinical and
radiological features of lung disorders related to connective-tissue diseases: a pictorial essay. Coronal multiplanar reformatted images. A, B demonstrate the presence of straight-edge sign in female RA patients showing interstitial lung fibrosis. This sign consists of a more pronounced fibrosis in the lung bases—with sharp demarcation in the cranio-caudal plane (white arrows in A, B)
Clinical and
radiological features of lung disorders related to connective-tissue diseases: a pictorial essay. Airway disease in RA patient, clearly depicted in A, B. Lobular decreased attenuation areas (white empty arrows) are caused by follicular bronchiolitis and obliterative bronchiolitis. This finding represents an early manifestation of disease, due to airway involvement—typically found when no fibrosing alterations are observed
Clinical and
radiological features of lung disorders related to connective-tissue diseases: a pictorial essay. Cavitate nodular lesions (white empty arrows in A, B) in a male RA patient. Rheumatoid nodules represent a rare manifestation of disease; generally, they have bilateral and subpleural location, with rounded shape. The development of cavitation has been reported in literature related to vasculitis. Left pneumothorax (white asterisk) is also evident along the anterior part of the lung
Rheumatoid
arthritis • Rheumatoid interstitial lung disease - UIP pattern - Ganzer Fall bei Radiopaedia
Rheumatoid
arthritis (pulmonary manifestations) • UIP pattern interstitial lung disease in rheumatoid arthritis - Ganzer Fall bei Radiopaedia
Rheumatoid
arthritis (pulmonary manifestations) • Rheumatoid interstitial lung disease (moderate) - Ganzer Fall bei Radiopaedia
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.
Epidemiology
Although RA is more common in women, respiratory disease more commonly develops in men .
Clinical presentation
Respiratory symptoms are often absent, or nonspecific such as dyspnea and chronic cough.
Pathology
Associations
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
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
- 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
- rheumatoid arthritis (general article)
- rheumatoid pulmonary vasculitis
Siehe auch:
- Pneumothorax
- Bronchiektasen
- Pleuraerguss
- Rheumatoide Arthritis
- Kryptogene organisierende Pneumonie (COP)
- Bronchiolitis obliterans
- non specific interstitial pneumonia (NSIP)
- gewöhnliche interstitielle Pneumonie (UIP)
- Caplan-Syndrom
- necrobiotic lung nodules
- Rheumaknoten Lunge
- follikuläre Bronchiolitis
- general discussion of rheumatoid arthritis
- musculoskeletal manifestations
- Pleuraverdickung
- superior rib notching
- muskuloskelettale Manifestationen rheumatoide Arthritis
und weiter:
Assoziationen und Differentialdiagnosen zu pulmonale Manifestationen rheumatoide Arthritis:
gewöhnliche
interstitielle Pneumonie (UIP)
