Fibrosing alveolitis in patients with rheumatoid arthritis asassessed by high resolution computed tomography chest radiography andpulmonary function tests

摘要

BACKGROUND—Fibrosing alveolitis (FA) is a common and serious complication of rheumatoid arthritis (RA). Before the availability of high resolution computed tomographic (HRCT) scanning, it was difficult to diagnose accurately without recourse to biopsy. Prospective studies have reported a prevalence of interstitial lung disease (ILD) of 19-44%. The term ILD used by these authors encompasses a variety of appearances on HRCT scans. This prospective study used HRCT scanning to determine the true prevalence of FA in hospital outpatients with RA, and to study associated clinical characteristics.
METHODS—One hundred and fifty consecutive patients with RA were selected from a hospital outpatient department, irrespective of the presence or absence of chest disease. All underwent a detailed clinical assessment, chest HRCT scanning, and conventional chest radiography within 4 weeks of full pulmonary function tests.
RESULTS—Seventy percent of patients were current or reformed cigarette smokers. Twenty eight (19%) had FA, most frequently of reticular pattern, and 12 ofthis group (43%) also had emphysematous bullae. None of the previouslysuggested risk factors for developing FA were confirmed. Fifty fourpercent of patients with HRCT evidence of FA had bilateral basal chestcrackles, 82% had a reduced carbon monoxide transfer factor(TLCO), 14% had restrictive pulmonary function tests, and14% had bilateral chest radiographic signs of FA.
CONCLUSIONS—HRCTevidence of FA was present in 19% of hospital outpatients with RA.Abnormalities on chest examination or on full pulmonary function tests,even without restrictive changes or chest radiographic abnormalities,should prompt physicians to request a chest HRCT scan wheninvestigating dyspnoea in patients with RA.