Abstract
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).
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Rémy-Jardin M, Rémy J, Cortet B, Mauri F, Delcambre B (1994) Lung changes in rheumatoid arthritis: CT findings. Radiology 193:375–382
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 200:327–331
Müller NL, Staples CA, Miller RR, Vedal S, Thurlbeck WM, Ostrow DN (1987) Disease activity in idiopathic pulmonary fibrosis: CT and pathological correlation. Radiology 165:731–734
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 171:613–618
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 20:305–308
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 150:771–776
Garcia JGN, James HL, Zinkgraf S, Perlman MB, Koegh BA (1987) Lower respiratory tract abnormalities in rheumatoid interstitial lung disease. Am Rev Respir Dis 136:811–817
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 133:574–580
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):A64
Gamsu G (1992) Radiographic manifestations of thoracic involvement by collagen vascular diseases. J Thorac Imaging 7:1–12
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 156:528–535
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 165:438–444
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 161:12–18
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 19:19–22
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 114:500–506
Anaya JM, Diethelm L, Ortiz LA, Guitierrez M, Citera G, Welsh RA, Espinoza LR (1995) Pulmonary involvement in rheumatoid arthritis. Semin Arthr Rheum 24:242–254
Perez T, Remy-Jardin M, Cortet B (1998) Airways involvement in rheumatoid arthritis: clinical, functional and HRCT findings. Am J Respir Crit Care Med 157:1658–1665
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 196:835–840
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 150:462–468
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 47:738–742
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–S87
Ellis SM, Hansell DM (2002) Idiopathic interstitial pneumonias: imaging-pathology correlation. Eur Radiol 12:610–626
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) 41:262–267
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 189:693–698
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 11:373–392
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 61:517–521
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 23:941–948
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 12:1504–1511
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 56:622–627
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 56:596–600
Garcia JGN, Parhami N, Killam D, Garcia PL, Keogh BA (1986) Bronchoalveolar lavage fluid evaluation in rheumatoid arthritis. Am Rev Respir Dis 133:450–454
Okuda Y, Takasugi K, Kurata N, Takahara J (1993) Bronchoalveolar lavage fluid analysis in rheumatoid arthritis. Ryumachi 33:302–309
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Biederer, J., Schnabel, A., Muhle, C. et al. Correlation between HRCT findings, pulmonary function tests and bronchoalveolar lavage cytology in interstitial lung disease associated with rheumatoid arthritis. Eur Radiol 14, 272–280 (2004). https://doi.org/10.1007/s00330-003-2026-1
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DOI: https://doi.org/10.1007/s00330-003-2026-1