Rheumatoid arthritis (pulmonary manifestations)
Updates to Article Attributes
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 RArheumatoid arthritis is more common in women, respiratory disease more commonly develops in men 6.
Clinical presentation
Respiratory symptoms are often absent, or nonspecific or non-specific such as dyspnoea and chronic cough.
Pathology
Associations
- bronchocentric granulomatosis: rare 7
Radiographic features
Patterns of lung involvement include interstitial, airway and pleural disease.
Pleural involvement is a common manifestation of RArheumatoid arthritis, 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 5
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 8
-
interstitial fibrosis
-(rheumatoid arthritis associated interstitial lung disease) -
organising pneumonia
-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 haemopneumothorax
.
-
follicular bronchiolitis: rare
- small centrilobular nodules or tree-in-bud
rare
- Caplan syndrome
See also
-<p><strong>Pulmonary manifestations </strong>are relatively common in<strong> rheumatoid arthritis,</strong> and like many of its non-articular manifestations, tend to develop later in the disease.</p><p>Please refer to the related articles for a <a href="/articles/rheumatoid-arthritis">general discussion of rheumatoid arthritis</a>, and for the specific discussion of its <a href="/articles/rheumatoid-arthritis-musculoskeletal-manifestations-2">musculoskeletal manifestations</a>.</p><h4>Epidemiology</h4><p>Although RA is more common in women, respiratory disease more commonly develops in men <sup>6</sup>.</p><h4>Clinical presentation</h4><p>Respiratory symptoms are often absent, or nonspecific such as dyspnoea and chronic cough. </p><h4>Pathology</h4><h5>Associations</h5><ul><li>- +<p><strong>Pulmonary manifestations </strong>are relatively common in<strong> rheumatoid arthritis,</strong> and like many of its non-articular manifestations, tend to develop later in the disease.</p><p>Please refer to the related articles for a <a href="/articles/rheumatoid-arthritis">general discussion of rheumatoid arthritis</a>, and for the specific discussion of its <a href="/articles/rheumatoid-arthritis-musculoskeletal-manifestations-2">musculoskeletal manifestations</a>.</p><h4>Epidemiology</h4><p>Although rheumatoid arthritis is more common in women, respiratory disease more commonly develops in men <sup>6</sup>.</p><h4>Clinical presentation</h4><p>Respiratory symptoms are often absent, or non-specific such as dyspnoea and chronic cough. </p><h4>Pathology</h4><h5>Associations</h5><ul><li>
-</li></ul><h4>Radiographic features</h4><p>Patterns of lung involvement include interstitial, airway and pleural disease.</p><p>Pleural involvement is a common manifestation of RA, although usually asymptomatic. </p><ul>- +</li></ul><h4>Radiographic features</h4><p>Patterns of lung involvement include interstitial, airway and pleural disease.</p><p>Pleural involvement is a common manifestation of rheumatoid arthritis, although usually asymptomatic. </p><ul>
-<a href="/articles/interstitial-pulmonary-fibrosis">interstitial fibrosis</a> - <a href="/articles/rheumatoid-arthritis-associated-interstitial-lung-disease">rheumatoid arthritis associated interstitial lung disease</a><ul>- +<a title="Pulmonary fibrosis" href="/articles/pulmonary-fibrosis">interstitial fibrosis</a> (<a href="/articles/rheumatoid-arthritis-associated-interstitial-lung-disease">rheumatoid arthritis associated interstitial lung disease</a>)<ul>
-<li>occurs in ~ 10% of RA patients <sup>3</sup>- +<li>occurs in ~10% of RA patients <sup>3</sup>
-<li>can have either a<a href="/articles/uip"> UIP</a> (slightly more common <sup>8</sup>) or <a href="/articles/non-specific-interstitial-pneumonia-1">NSIP</a> pattern</li>- +<li>can have either a <a href="/articles/uip">UIP</a> (slightly more common <sup>8</sup>) or <a href="/articles/non-specific-interstitial-pneumonia-1">NSIP</a> pattern</li>
-<li>-<a href="/articles/cryptogenic-organising-pneumonia-1">COP</a> - <a href="/articles/cryptogenic-organising-pneumonia-1">BOOP</a>-</li>- +<li><a title="Organising pneumonia" href="/articles/organising-pneumonia">organising pneumonia</a></li>
-<li>cavitation of a peripheral nodule can lead to <a href="/articles/pneumothorax">pneumothorax</a> or <a href="/articles/haemopneumothorax">haemopneumothorax</a>.</li>- +<li>cavitation of a peripheral nodule can lead to <a href="/articles/pneumothorax">pneumothorax</a> or <a href="/articles/haemopneumothorax">haemopneumothorax</a>
- +</li>
-<a href="/articles/follicular-bronchiolitis">follicular bronchiolitis</a><ul>-<li>small centrilobular nodules or <a href="/articles/tree-in-bud-sign-lung">tree-in-bud</a>-</li>-<li>rare</li>-</ul>- +<a href="/articles/follicular-bronchiolitis">follicular bronchiolitis</a>: rare<ul><li>small centrilobular nodules or <a href="/articles/tree-in-bud-sign-lung">tree-in-bud</a>
- +</li></ul>