European Radiology

, Volume 14, Issue 2, pp 272–280 | Cite as

Correlation between HRCT findings, pulmonary function tests and bronchoalveolar lavage cytology in interstitial lung disease associated with rheumatoid arthritis

  • J. BiedererEmail author
  • A. Schnabel
  • C. Muhle
  • W. L. Gross
  • M. Heller
  • M. Reuter


A prospective study correlating high-resolution computed tomography (HRCT), lung function tests (PFT) and bronchoalveolar lavage (BAL) cytology in patients with interstitial lung disease (ILD) associated with rheumatoid arthritis (RA). Fifty-three RA patients with suspected ILD (19 men, 34 women) underwent 71 HRCT (14 of 53 with sequential HRCT, mean follow-up 24.3 months). The HRCT evaluation by two observers on consensus included a semi-quantitative characterisation of lesion pattern and profusion on representative anatomical levels. Fifty-two HRCT were followed by PFT and BAL. Agreement or discordance of HRCT-, PFT- and BAL findings were analysed with Pearson’s correlation, κ score and McNemar’s test. Tobacco-fume exposure was estimated in pack years. Smoking/non-smoking groups were compared with Student’s t test. In 49 of 53 patients, HRCT was suggestive of ILD associated with RA (66 of 71 HRCT). Reticular lesions were found in 40 of 53 patients, in 15 of 40 presenting as mixed pattern with ground-glass opacities (GGO). Pure reticular patterns predominated in patients with long duration of ILD (p>0.01). Pure GGO were not observed. Lesion profusion was highly variable and correlated moderately negative with diffusion capacity (mean 88.2% (SD±20.9%); r=−0.54; p<0.001) and very weak with vital capacity and FEV1 (mean values 92.2% (SD±18.3%); r=−0.27; p<0.05 and 89.8% (SD±17.5%); r=−0.31; p<0.01). In patients with GGO, BAL differentials tended towards neutrophilia (κ=0.39; p=0.04; McNemar test p>0.2), but not towards lymphocytosis (κ=0.10; p=0.23; McNemar test p>0.2). Differences in smoking history were not significant (p>0.1). The HRCT appears most appropriate for the detection and follow-up of ILD associated with RA. The PFT and BAL correlate only partially with lesion profusion or grading on HRCT, but they contribute valuable information about dynamic lung function and differential diagnoses (pneumonia, medication side effects).


HRCT Rheumatoid arthritis Interstitial lung disease BAL 


  1. 1.
    Rémy-Jardin M, Rémy J, Cortet B, Mauri F, Delcambre B (1994) Lung changes in rheumatoid arthritis: CT findings. Radiology 193:375–382PubMedGoogle Scholar
  2. 2.
    Austin JHM, Müller NL, Friedman PJ, Hansell D, Naidich DP, Rémy-Jardin M, Webb WR, Zerhouni EA (1996) Glossary of terms for CT of the lungs: recommendations of the nomenclature committee of the Fleischner Society. Radiology 200:327–331PubMedGoogle Scholar
  3. 3.
    Müller NL, Staples CA, Miller RR, Vedal S, Thurlbeck WM, Ostrow DN (1987) Disease activity in idiopathic pulmonary fibrosis: CT and pathological correlation. Radiology 165:731–734PubMedGoogle Scholar
  4. 4.
    Müller NL, Mawson JB, Mathieson JR, Abboud R, Ostrow DN, Champion P (1989) Sarcoidosis: correlation of extent of disease at CT with clinical, functional, and radiographic findings. Radiology 171:613–618PubMedGoogle Scholar
  5. 5.
    Niimi H, Kang EY, Kwong JS, Carignan S, Müller NL (1996) CT of chronic infiltrative lung disease: prevalence of mediastinal lymphadenopathy. J Comput Assist Tomogr 20:305–308CrossRefPubMedGoogle Scholar
  6. 6.
    Kiyono K, Sone S, Sakai F, Imai Y, Watanabe T, Izuno I, Oguchi M, Kawai T, Shigematsu H, Watanabe M (1988) The number and size of normal mediastinal lymph nodes: a postmortem study. Am J Radiol 150:771–776Google Scholar
  7. 7.
    Garcia JGN, James HL, Zinkgraf S, Perlman MB, Koegh BA (1987) Lower respiratory tract abnormalities in rheumatoid interstitial lung disease. Am Rev Respir Dis 136:811–817PubMedGoogle Scholar
  8. 8.
    Wallaert B, Hatron PY, Grosbois JM, Tonnel AB, Devulder B, Voisin C (1986) Subclinical pulmonary involvement in collagen-vascular diseases assessed by bronchoalveolar lavage. Am Rev Respir Dis 133:574–580PubMedGoogle Scholar
  9. 9.
    Dawson JK, Graham DR, Kenny J, Du Bois RM, Lynch MP (1997) HRCT diagnosed lung disease in patients with rheumatoid arthritis. Thorax 52 (Suppl 6):A64Google Scholar
  10. 10.
    Gamsu G (1992) Radiographic manifestations of thoracic involvement by collagen vascular diseases. J Thorac Imaging 7:1–12Google Scholar
  11. 11.
    Gabbay E, Tarala R, Will R, Carrol G, Adler B, Cameron D, Lake FR (1997) Interstitial lung disease in recent onset rheumatoid arthritis. Am J Respir Crit Care Med 156:528–535PubMedGoogle Scholar
  12. 12.
    Müller-Leisse C, Bussmann A, Meyer O, Vorbrüggen W, Genth E, Günther RW (1996) Lungenmanifestation bei rheumatoider arthritis: hochauflösende computertomographie in wechselbeziehung zur skelettmanifestation und zu laborchemischen veränderungen. Fortschr Röntgenstr 165:438–444Google Scholar
  13. 13.
    Müller-Leisse C, Bussmann A, Meyer O, Genth E, Günther RW (1994) Hochauflösende computertomographie der lunge bei kollagenosen: eine prospektive untersuchung an 73 patienten. Fortschr Röntgenstr 161:12–18Google Scholar
  14. 14.
    Demir R, Bodur H, Tokoglu F, Olcay I, Ucan H, Borman P (1999) High-resolution computed tomography of the lungs in patients with rheumatoid arthritis. Rheumatol Int 19:19–22CrossRefPubMedGoogle Scholar
  15. 15.
    Reuter M, Schnabel A, Wesner F, Tetzlaff K, Risheng Y, Gross WL, Heller M (1998) Pulmonary Wegener’s granulomatosis: correlation between high-resolution CT findings and clinical scoring of disease activity. Chest 114:500–506PubMedGoogle Scholar
  16. 16.
    Anaya JM, Diethelm L, Ortiz LA, Guitierrez M, Citera G, Welsh RA, Espinoza LR (1995) Pulmonary involvement in rheumatoid arthritis. Semin Arthr Rheum 24:242–254Google Scholar
  17. 17.
    Perez T, Remy-Jardin M, Cortet B (1998) Airways involvement in rheumatoid arthritis: clinical, functional and HRCT findings. Am J Respir Crit Care Med 157:1658–1665PubMedGoogle Scholar
  18. 18.
    Bankier AA, Kiener HP, Wiesmayr MN, Fleischmann D, Kontrus M, Herold CJ, Graninger W, Hübsch P (1995) Discrete lung involvement in systemic lupus erythematosus: CT assessment. Radiology 196:835–840PubMedGoogle Scholar
  19. 19.
    Wells AU, Hansell M, Rubens MB, Cullinan P, Haslam P, Du Bois RM (1994) Fibrosing alveolitis in systemic sclerosis. Am J Respir Crit Care Med 150:462–468PubMedGoogle Scholar
  20. 20.
    Wells AU, Hansell DM, Corrin B, Harrison LK, Goldstraw P, Black CM, Du Bois RM (1992) High-resolution computed tomography as a predictor of lung histology in systemic sclerosis. Thorax 47:738–742PubMedGoogle Scholar
  21. 21.
    Rémy-Jardin M, Rémy J, Artaud D, Fribourg M, Bonnel F, Copin MC, Gosselin (2000) HRCT-pathologic correlation in chronic diffuse infiltrative lung disease. Eur Radiol 10:S79–S87Google Scholar
  22. 22.
    Ellis SM, Hansell DM (2002) Idiopathic interstitial pneumonias: imaging-pathology correlation. Eur Radiol 12:610–626PubMedGoogle Scholar
  23. 23.
    Dawson JK, Graham DR, Desmond J, Fewins HE, Lynch MP (2002) Investigation of the chronic pulmonary effects of low-dose oral methotrexate in patients with rheumatoid arthritis: a prospective study incorporating HRCT scanning and pulmonary function tests. Rheumatology (Oxford) 41:262–267Google Scholar
  24. 24.
    Remy-Jardin M, Giraud F, Remy J, Copin MC, Gosselin B (1993) Importance of ground-glass attenuation in chronic diffuse infiltrative lung disease: pathologic-CT correlation. Radiology 189:693–698PubMedGoogle Scholar
  25. 25.
    Schaefer-Prokop C, Prokop M, Fleischmann D, Herold C (2001) High-resolution CT of diffuse interstitial lung disease: key findings in common disorders. Eur Radiol 11:373–392PubMedGoogle Scholar
  26. 26.
    Dawson JK, Fewins HE, Desmond J, Lynch MP, Graham DR (2002) Predictors of progression of HRCT diagnosed fibrosing alveolitis in patients with rheumatoid arthritis. Ann Rheum Dis 61:517–521CrossRefPubMedGoogle Scholar
  27. 27.
    Akira M, Sakatani M, Hara H (1999) Thin-section CT findings in rheumatoid arthritis-associated lung disease: CT patterns and their courses. J Comput Assist Tomogr 23:941–948CrossRefPubMedGoogle Scholar
  28. 28.
    Taouli B, Brauner MW, Mourey I, Lemouchi D, Grenier PA (2002) Thin-section chest CT findings of primary Sjogren’s syndrome: correlation with pulmonary function. Eur Radiol 12:1504–1511CrossRefPubMedGoogle Scholar
  29. 29.
    Dawson JK, Fewins HE, Desmond J, Lynch MP, Graham DR (2001) Fibrosing alveolitis in patients with rheumatoid arthritis as assessed with high-resolution computed tomography, chest radiography and pulmonary function tests. Thorax 56:622–627CrossRefPubMedGoogle Scholar
  30. 30.
    Cortet B, Perez T, Roux N, Flipo R-M, Duquesnoy B, Delcambre B, Rémy-Jardin M (1997) Pulmonary function tests and high-resolution computed tomography of the lungs in patients with rheumatoid arthritis. Ann Rheum Dis 56:596–600PubMedGoogle Scholar
  31. 31.
    Garcia JGN, Parhami N, Killam D, Garcia PL, Keogh BA (1986) Bronchoalveolar lavage fluid evaluation in rheumatoid arthritis. Am Rev Respir Dis 133:450–454PubMedGoogle Scholar
  32. 32.
    Okuda Y, Takasugi K, Kurata N, Takahara J (1993) Bronchoalveolar lavage fluid analysis in rheumatoid arthritis. Ryumachi 33:302–309PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • J. Biederer
    • 1
    Email author
  • A. Schnabel
    • 2
    • 3
  • C. Muhle
    • 1
  • W. L. Gross
    • 2
    • 3
  • M. Heller
    • 1
  • M. Reuter
    • 1
  1. 1.Department of Diagnostic RadiologyChristian Albrechts University KielKielGemany
  2. 2.Department of Clinical RheumatologyUniversity of LübeckLübeckGermany
  3. 3.Rheumaklinik Bad BramstedtBad BramstedtGermany

Personalised recommendations