Clinical Rheumatology

, Volume 23, Issue 2, pp 123–128 | Cite as

Lung findings on thoracic high-resolution computed tomography in patients with ankylosing spondylitis. Correlations with disease duration, clinical findings and pulmonary function testing

  • Abdellah El Maghraoui
  • Souad Chaouir
  • Ahmed Abid
  • Ahmed Bezza
  • Fatima Tabache
  • Lahsen Achemlal
  • Ali Abouzahir
  • Driss Ghafir
  • Victor Ohayon
  • Moulay Idriss Archane
Original Article


The aim of this study was to identify the spectrum of abnormalities revealed on high-resolution computerized tomography (HRCT) in patients with ankylosing spondylitis (AS), to compare findings with those of plain radiography and pulmonary function testing (PFT), and to look for correlations between lung involvement and AS severity. We prospectively studied 55 consecutive patients with a diagnosis of AS according to the modified New York criteria who attended our department over a period of 2 years. All patients had a detailed rheumatological examination and underwent plain chest radiography, chest HRCT and PFT. HRCT revealed abnormalities in 29 patients (52.7%), whereas plain chest radiography was abnormal in only 2. Abnormalities consisted of interstitial lung disease (ILD) (n=4), apical fibrosis (n=5), emphysema (n=5), bronchiectasis (n=4), ground glass attenuation (n=2), and non-specific interstitial abnormalities (n=26). Only apical fibrosis and bronchiectasis were statistically more frequent with increasing disease duration (significant trend χ2test, p=0.0029 and 0.028, respectively). PFT showed a restrictive process in 19 patients (34.5%). No correlation was noted between HRCT and PFT, nor with AS symptomatic and structural severity parameters. However, there was a statistically significant correlation between PFT and AS symptomatic and structural severity parameters. In conclusion,: this study confirms that the chest HRCT of patients with AS showed a great number of abnormalities undetectable by standard X-rays. The high incidence of lung abnormalities emphasizes the importance of excluding such a diagnosis in patients with AS even without respiratory symptoms.


Ankylosing spondylitis High-resolution computerized tomography Lung 



Apical fibrosis


Ankylosing spondylitis


Forced vital capacity


Forced expiratory volume in 1 s


High-resolution computerized tomography


Interstitial lung disease


Pulmonary function tests


Vital capacity



We thank Professor R. Abouqual and Dr I. Jroundi for statistical help. Supported in part by a grant from Pfizer.


  1. 1.
    El Maghraoui A, Bensabbah R, Bahiri R, Bezza A, Guedira N, Hajjaj-Hassouni N (2003) Cervical spine involvement in ankylosing spondylitis. Clin Rheum 22:94–98CrossRefGoogle Scholar
  2. 2.
    El Maghraoui A, Dougados M, Freneaux E, Chaussade S, Amor B, Breban M (1999) Concordance between abdominal scintigraphy using technetium-99m hexamethylpropylene amine oxime-labelled leucocytes and ileocolonoscopy in patients with spondyloarthropathies and without clinical evidence of inflammatory bowel disease. Rheumatology 38:543–546CrossRefPubMedGoogle Scholar
  3. 3.
    El Maghraoui A, Chaouir S, Bezza A et al. (2003) Thoracic high-resolution CT in patients with ankylosing spondylitis and without respiratory symptoms. Ann Rheum Dis 62:185–186CrossRefPubMedGoogle Scholar
  4. 4.
    Davies D (1972) Ankylosing spondylitis and lung fibrosis. QJ Med 41:395–417Google Scholar
  5. 5.
    Appelrouth D, Gottlieb NL (1975) Pulmonary manifestations of ankylosing spondylitis. J Rheumatol 2:446–453PubMedGoogle Scholar
  6. 6.
    Feltelius N, Hedenstrom H, Hillerdal G, Hallgren R (1986) Pulmonary involvement in ankylosing spondylitis. Ann Rheum Dis 45:736–740PubMedGoogle Scholar
  7. 7.
    Bouchea DK, Sundstrom WR (1989) The pleuropulmonary manifestations of ankylosing spondylitis. Semin Arthritis Rheum 18:277–281PubMedGoogle Scholar
  8. 8.
    Rumanik WM, Firooznia H, Davis MS Jr et al. (1984) Fibrobullous disease of the upper lobes: an extraskeletal manifestation of ankylosing spondylitis. J Comput Tomogr 8:225–229PubMedGoogle Scholar
  9. 9.
    Ferdoutis M, Bouros D, Meletis G et al. (1995) Diffuse interstitial lung disease as an early manifestation of ankylosing spondylitis. Respiration 62:286–289PubMedGoogle Scholar
  10. 10.
    Hurwitz SS, Conlan AA, Krige LP (1982) Fibrocavitating pulmonary lesions in ankylosing spondylitis. S Afr Med J 61:168–170PubMedGoogle Scholar
  11. 11.
    Van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York Criteria. Arthritis Rheum 4:361–368Google Scholar
  12. 12.
    Jenkinson TR, Mallorie PA, Whitelock HC, Kennedy LG, Garrett SL, Calin A (1994) Defining spinal mobility in ankylosing spondylitis. The Bath Ankylosing Spondylitis Metrology Index (BASMI). J Rheumatol 21:1694–1698PubMedGoogle Scholar
  13. 13.
    Calin A, Garrett S, Whitelock HC et al. (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21:2281–2285PubMedGoogle Scholar
  14. 14.
    Garret S, Jenkinson T, Kennedy LG, Whitelock HC, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis : the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21:2286–2291PubMedGoogle Scholar
  15. 15.
    Jones SD, Steiner A, Garrett SL, Calin A (1995) the Bath Ankylosing Spondylitis Patient Global Score [abstract]. Br J Rheumatol 34 Suppl 1:114Google Scholar
  16. 16.
    Bennet PH, Burch TA (1967) New York symposium on population studies in the rheumatic diseases: new diagnostic criteria. Bull Rheum Dis 28:453–458Google Scholar
  17. 17.
    Larsen A, Dale K, Morten E (1977) Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference film. Acta Radiol 18:481–491Google Scholar
  18. 18.
    El Maghraoui A, Borderie D, Edouard R, Roux C, Dougados M (1999) Osteoporosis, body composition and bone turnover in ankylosing spondylitis. J Rheumatol 26:2205–2209PubMedGoogle Scholar
  19. 19.
    Maillefert JF, Aho S, El Maghraoui A, Dougados M, Roux C (2001) Changes in bone density in patients with ankylosing spondylitis: a two year follow-up study. Osteoporosis Int 12:605–609CrossRefGoogle Scholar
  20. 20.
    MacKay K, Mack C, Brophy S, Calin A (1998) The Bath Ankylosing Spondylitis Radiology Index (BASRI): a new, validated approach to disease assessment. Arthritis Rheum 41:2263–2270CrossRefPubMedGoogle Scholar
  21. 21.
    Calin A. Mackay K. Santos H. Brophy S (1999) A new dimension to outcome: application of the Bath Ankylosing Spondylitis Radiology Index. J Rheumatol 26:988–992PubMedGoogle Scholar
  22. 22.
    Dunham CL, Kautz FG (1941) Spondylarthritis ankylopoietica : a review of and report of twenty cases. Am J Med Sci 201:232–250Google Scholar
  23. 23.
    Hamilton KA (1949) Pulmonary disease manifestations of ankylosing spondylarthritis. Ann Intern Med 31:216–227Google Scholar
  24. 24.
    Rosenow CE, Strimlan CV, Muhm JR, Ferguson RH (1977) Pleuropulmonary manifestations of ankylosing spondylitis. Mayo Clin Proc 52:641–649PubMedGoogle Scholar
  25. 25.
    Hansell DM, Kerr IH (1991) The role of high resolution tomography in the diagnosis of interstitial lung disease. Thorax 46:77–84PubMedGoogle Scholar
  26. 26.
    Gamsu G, Klein JS (1989) High resolution computed tomography of diffuse lung disease. Clin Radiol 40:554–556PubMedGoogle Scholar
  27. 27.
    Canvin JMG, MacPherson BCM, Sturrock RD (1995) High prevalence of apical pulmonary fibrosis in ankylosing spondylitis by high resolution computed tomography. Br J Rheumatol 34 (abstracts suppl): n°223Google Scholar
  28. 28.
    Casserly IP, Fenlon HM, Breanatch E et al. (1997) Lung findings on high-resolution computed tomography in idiopathic ankylosing spondylitis. Correlation with clinical findings, pulmonary function testing and plain radiography. Br J Rheumatol 36:677–682CrossRefPubMedGoogle Scholar
  29. 29.
    Fenlon HM, Casserly I, Sant SM et al. (1997) Plain radiographs and thoracic high-resolution computed tomography in patients with ankylosing spondylitis. Am J Roentgenol 168:1067–1072Google Scholar
  30. 30.
    Turetschek K, Ebner W, Fleischmann D et al. (2000) Early pulmonary involvement in ankylosing spondylitis: assessment with thin-section CT. Clin Radiol 55:632–636CrossRefPubMedGoogle Scholar
  31. 31.
    Senocak O, Manisaly M, Ozaksoy D, Sevinc C¸ Akalyn E (2003) Lung parenchyma changes in ankylosing spondylitis: demonstration with high resolution CT and correlation with disease duration. Eur J Radiol 45:117–122CrossRefPubMedGoogle Scholar
  32. 32.
    Fournie B, Boutes A, Dromer C et al. (1997) Prospective study of anterior chest wall involvement in ankylosing spondylitis and psoriatic arthritis. Joint Bone Spine 64:22–25Google Scholar
  33. 33.
    Cerraholugu L, Unlu Z, Can M, Goktan C, Celik P (2002) lumbar stifness but not radiographic changes relate to alteration of lung function tests in ankylosing spondylitis. Clin Rheumatol 21:275–279CrossRefPubMedGoogle Scholar
  34. 34.
    Zorab PA (1962) The lungs in ankylosing spondylitis. Q J Med 123:267–277Google Scholar
  35. 35.
    Cohen AA, Natelson EA, Fechner RE (1971) Fibrosing interstitial pneumonitis. Chest 59:369–371PubMedGoogle Scholar
  36. 36.
    Wells AU, Hansell DM, Corrin B et al. (1992) High resolution computed tomography as a predictor of lung histology in systemic sclerosis. Thorax 53:738–742Google Scholar

Copyright information

© Clinical Rheumatology 2004

Authors and Affiliations

  • Abdellah El Maghraoui
    • 1
  • Souad Chaouir
    • 2
  • Ahmed Abid
    • 3
  • Ahmed Bezza
    • 1
  • Fatima Tabache
    • 1
  • Lahsen Achemlal
    • 1
  • Ali Abouzahir
    • 1
  • Driss Ghafir
    • 1
  • Victor Ohayon
    • 1
  • Moulay Idriss Archane
    • 1
  1. 1.Internal Medicine DepartmentMilitary Hospital Mohamed VRabatMorocco
  2. 2.Radiology DepartmentMilitary Hospital Mohamed VRabatMorocco
  3. 3.Pneumology DepartmentMilitary Hospital Mohamed VRabatMorocco

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