Rheumatoid Arthritis–related Lung Diseases: CT Findings

PURPOSE: To evaluate computed tomographic (CT) findings of rheumatoid arthritis–related lung disease and categorize findings according to pathologic features.

MATERIALS AND METHODS: CT scans obtained in 63 patients (27 men, 36 women; mean age, 61.7 years ± 11.2 [SD]; range, 28–81 years) with rheumatoid arthritis were assessed. Mean duration of disease was 7.6 years ± 9.2. Lung parenchymal abnormalities that included airspace consolidation, ground-glass opacity (GGO), reticulation, honeycombing, nodules, bronchiectasis, and air trapping were assessed retrospectively by two chest radiologists. Final decision was reached with consensus of these radiologists and a third radiologist. Patients were classified according to the predominant CT pattern. One of the chest radiologists and a pulmonary pathologist compared CT findings with pathologic findings in 17 patients. Interobserver agreement between the first two radiologists was assessed. Correlation between CT finding extent score and pulmonary function test results was estimated with Spearman rank correlation coefficient.

RESULTS: GGO (57 [90%] patients) and reticulation (62 [98%] patients) were the most common CT features. Four major CT patterns were identified: usual interstitial pneumonia (n = 26), nonspecific interstitial pneumonia (n = 19), bronchiolitis (n = 11), and organizing pneumonia (n = 5). Usual interstitial pneumonia and nonspecific interstitial pneumonia CT patterns overlapped; GGO was more extensive in patients with nonspecific interstitial pneumonia CT pattern (P = .028). In 17 patients who underwent biopsy, CT findings reflected pathologic findings. Exceptions were two patients classified with usual interstitial pneumonia at CT but with nonspecific interstitial pneumonia at pathologic analysis; one patient, with nonspecific interstitial pneumonia at CT but desquamative interstitial pneumonia at pathologic analysis; and one patient, with lymphoid interstitial pneumonia at CT but nonspecific interstitial pneumonia at pathologic analysis.

CONCLUSION: Rheumatoid arthritis is associated with four CT patterns: usual interstitial pneumonia, nonspecific interstitial pneumonia, bronchiolitis, and organizing pneumonia. The most common CT features of rheumatoid arthritis–related lung disease were GGO and reticulation.

© RSNA, 2004


  • 1 Anaya JM, Diethelm L, Ortiz LA, et al. Pulmonary involvement in rheumatoid arthritis. Semin Arthritis Rheum 1995; 24:242-254. Crossref, MedlineGoogle Scholar
  • 2 Shannon TM, Gale ME. Noncardiac manifestations of rheumatoid arthritis in the thorax. J Thorac Imaging 1992; 7:19-29. Crossref, MedlineGoogle Scholar
  • 3 Tanoue LT. Pulmonary manifestations of rheumatoid arthritis. Clin Chest Med 1998; 19:667-685. Crossref, MedlineGoogle Scholar
  • 4 Remy-Jardin M, Remy J, Cortet B, Mauri F, Delcambre B. Lung changes in rheumatoid arthritis: CT findings. Radiology 1994; 193:375-382. LinkGoogle Scholar
  • 5 Steinberg DL, Webb WR. CT appearances of rheumatoid lung disease. J Comput Assist Tomogr 1984; 8:881-884. Crossref, MedlineGoogle Scholar
  • 6 Akira M, Sakatani M, Hara H. Thin-section CT findings in rheumatoid arthritis-associated lung disease: CT patterns and their courses. J Comput Assist Tomogr 1999; 23:941-948. Crossref, MedlineGoogle Scholar
  • 7 Fujii M, Adachi S, Shimizu T, Hirota S, Sako M, Kono M. Interstitial lung disease in rheumatoid arthritis: assessment with high-resolution computed tomography. J Thorac Imaging 1993; 8:54-62. Crossref, MedlineGoogle Scholar
  • 8 McDonagh J, Greaves M, Wright AR, Heycock C, Owen JP, Kelly C. High-resolution computed tomography of the lungs in patients with rheumatoid arthritis and interstitial lung disease. Br J Rheumatol 1994; 33:118-122. Crossref, MedlineGoogle Scholar
  • 9 Fewins HE, McGowan I, Whitehouse GH, Williams J, Mallya R. High definition computed tomography in rheumatoid arthritis associated pulmonary disease. Br J Rheumatol 1991; 30:214-216. Crossref, MedlineGoogle Scholar
  • 10 Cervantes-Perez P, Toro-Perez AH, Rodriguez-Jurado P. Pulmonary involvement in rheumatoid arthritis. JAMA 1980; 243:1715-1719. Crossref, MedlineGoogle Scholar
  • 11 Balagopal VP, de Costa P, Greenstone MA. Fatal pulmonary hypertension and rheumatoid vasculitis. Eur Respir J 1995; 8:331-333. Crossref, MedlineGoogle Scholar
  • 12 Hayakawa H, Sato A, Imokawa S, Toyosima M, Chida K, Iwata M. Bronchiolar disease in rheumatoid arthritis. Am J Respir Crit Care Med 1996; 154:1531-1536. Crossref, MedlineGoogle Scholar
  • 13 Geddes DM, Webley M, Emerson PA. Airways obstruction in rheumatoid arthritis. Ann Rheum Dis 1979; 38:222-225. Crossref, MedlineGoogle Scholar
  • 14 Howling SJ, Hansell DM, Wells AU, Nicholson AG, Flint JD, Müller NL. Follicular bronchiolitis: thin-section CT and histologic findings. Radiology 1999; 212:637-642. LinkGoogle Scholar
  • 15 Begin R, Masse S, Cantin A, Menard HA, Bureau MA. Airway disease in a subset of nonsmoking rheumatoid patients: characterization of the disease and evidence for an autoimmune pathogenesis. Am J Med 1982; 72:743-750. Crossref, MedlineGoogle Scholar
  • 16 Herzog CA, Miller RR, Hoidal JR. Bronchiolitis and rheumatoid arthritis. Am Rev Respir Dis 1981; 124:636-639. MedlineGoogle Scholar
  • 17 Perez T, Remy-Jardin M, Cortet B. Airways involvement in rheumatoid arthritis: clinical, functional, and HRCT findings. Am J Respir Crit Care Med 1998; 157:1658-1665. Crossref, MedlineGoogle Scholar
  • 18 Vergnenegre A, Pugnere N, Antonini MT, et al. Airway obstruction and rheumatoid arthritis. Eur Respir J 1997; 10:1072-1078. Crossref, MedlineGoogle Scholar
  • 19 Shadick NA, Fanta CH, Weinblatt ME, O’Donnell W, Coblyn JS. Bronchiectasis: a late feature of severe rheumatoid arthritis. Medicine (Baltimore) 1994; 73:161-170. Crossref, MedlineGoogle Scholar
  • 20 Yousem SA, Colby TV, Carrington CB. Lung biopsy in rheumatoid arthritis. Am Rev Respir Dis 1985; 131:770-777. MedlineGoogle Scholar
  • 21 Silman AJ. The 1987 revised American Rheumatism Association criteria for rheumatoid arthritis. Br J Rheumatol 1988; 27:341-343. Crossref, MedlineGoogle Scholar
  • 22 American Thoracic Society; European Respiratory Society. American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee, June 2001. Am J Respir Crit Care Med 2002; 165:277-304. Google Scholar
  • 23 Lynch DA. High-resolution CT of idiopathic interstitial pneumonias. Radiol Clin North Am 2001; 39:1153-1170. Crossref, MedlineGoogle Scholar
  • 24 Reynolds JH, Hansell DM. The interstitial pneumonias: understanding the acronyms. Clin Radiol 2000; 55:249-260. Crossref, MedlineGoogle Scholar
  • 25 Müller NL, Colby TV. Idiopathic interstitial pneumonias: high-resolution CT and histologic findings. RadioGraphics 1997; 17:1016-1022. LinkGoogle Scholar
  • 26 Epler GR. Heterogeneity of bronchiolitis obliterans organizing pneumonia. Curr Opin Pulm Med 1998; 4:93-97. Crossref, MedlineGoogle Scholar
  • 27 Lee KS, Kullnig P, Hartman TE, Müller NL. Cryptogenic organizing pneumonia: CT findings in 43 patients. AJR Am J Roentgenol 1994; 162:543-546. Crossref, MedlineGoogle Scholar
  • 28 Preidler KW, Szolar DM, Moelleken S, Tripp R, Schreyer H. Distribution pattern of computed tomography findings in patients with bronchiolitis obliterans organizing pneumonia. Invest Radiol 1996; 31:251-255. Crossref, MedlineGoogle Scholar
  • 29 Kim TS, Lee KS, Chung MP, et al. Nonspecific interstitial pneumonia with fibrosis: high-resolution CT and pathologic findings. AJR Am J Roentgenol 1998; 171:1645-1650. Crossref, MedlineGoogle Scholar
  • 30 MacDonald SL, Rubens MB, Hansell DM, et al. Nonspecific interstitial pneumonia and usual interstitial pneumonia: comparative appearances at and diagnostic accuracy of thin-section CT. Radiology 2001; 221:600-605. LinkGoogle Scholar
  • 31 Johkoh T, Müller NL, Pickford HA, et al. Lymphocytic interstitial pneumonia: thin-section CT findings in 22 patients. Radiology 1999; 212:567-572. LinkGoogle Scholar
  • 32 Ichikado K, Johkoh T, Ikezoe J, et al. Acute interstitial pneumonia: high-resolution CT findings correlated with pathology. AJR Am J Roentgenol 1997; 168:333-338. Crossref, MedlineGoogle Scholar
  • 33 Johkoh T, Müller NL, Taniguchi H, et al. Acute interstitial pneumonia: thin-section CT findings in 36 patients. Radiology 1999; 211:859-863. LinkGoogle Scholar
  • 34 Primack SL, Hartman TE, Ikezoe J, Akira M, Sakatani M, Müller NL. Acute interstitial pneumonia: radiographic and CT findings in nine patients. Radiology 1993; 188:817-820. LinkGoogle Scholar
  • 35 Akira M, Hamada H, Sakatani M, Kobayashi C, Nishioka M, Yamamoto S. CT findings during phase of accelerated deterioration in patients with idiopathic pulmonary fibrosis. AJR Am J Roentgenol 1997; 168:79-83. Crossref, MedlineGoogle Scholar
  • 36 Hwang JH, Kim TS, Lee KS, et al. Bronchiolitis in adults: pathology and imaging. J Comput Assist Tomogr 1997; 21:913-919. Crossref, MedlineGoogle Scholar
  • 37 Lau DM, Siegel MJ, Hidebolt CF, Cohen AH. Bronchiolitis obliterans syndrome: thin-section CT diagnosis of obstructive changes in infants and young children after lung transplantation. Radiology 1998; 208:783-788. LinkGoogle Scholar
  • 38 Worthy SA, Park CS, Kim JS, Müller NL. Bronchiolitis obliterans after lung transplantation: high-resolution CT findings in 15 patients. AJR Am J Roentgenol 1997; 169:673-677. Crossref, MedlineGoogle Scholar
  • 39 Kuriyama K, Gamsu G, Stern RG, Cann CE, Herfkens RJ, Brundage BH. CT-determined pulmonary artery diameters in predicting pulmonary hypertension. Invest Radiol 1984; 19:16-22. Crossref, MedlineGoogle Scholar
  • 40 Glazer GM, Gross BH, Quint LE, Francis IR, Bookstein FL, Orringer MB. Normal mediastinal lymph nodes: number and size according to the American Thoracic Society mapping. AJR Am J Roentgenol 1985; 144:261-265. Crossref, MedlineGoogle Scholar
  • 41 American Thoracic Society. Lung function testing: selection of reference values and interpretative strategies. Am Rev Respir Dis 1991; 144:1202-1218. Crossref, MedlineGoogle Scholar
  • 42 Katzenstein AL, Fiorelli RF. Nonspecific interstitial pneumonia/fibrosis: histologic features and clinical significance. Am J Surg Pathol 1994; 18:136-147. Crossref, MedlineGoogle Scholar
  • 43 Johkoh T, Müller NL, Cartier Y, et al. Idiopathic interstitial pneumonias: diagnostic accuracy of thin-section CT in 129 patients. Radiology 1999; 211:555-560. LinkGoogle Scholar
  • 44 Nishimura K, Itoh H. High-resolution computed tomographic features of bronchiolitis obliterans organizing pneumonia. Chest 1992; 102:26S-31S. Crossref, MedlineGoogle Scholar

Article History

Published in print: July 2004