- Rheumatoid Nodules:
- Pleuritis:
- Pulmonary Hypertension:
- ILD
- Usual Interstitial Pneumonia (UIP): UIP
- is the most common pattern
- Nonspecific Interstitial Pneumonia (NSIP): NSIP
- may have a better prognosis compared to UIP,
- Organizing Pneumonia (OP):
- Follicular Bronchiolitis
- Rheumatoid Nodule-Associated Lung Disease:
- Pleuroparenchymal Fibroelastosis (PPFE):
- Usual Interstitial Pneumonia (UIP): UIP
- Caplan Syndrome:
- pneumoconiosis) in individuals with
- RA
- Increased Infection Risk:
- Drug-Induced Lung Disease:
- Bronchiectasis:
Pulmonary Manifestations of Rheumatoid Arthritis (RA)
| Category | Specific Condition | CT/Imaging Findings | Key Features / Associations |
|---|---|---|---|
| Interstitial Lung Disease (ILD) | Usual Interstitial Pneumonia (UIP) | Basal reticulation, honeycombing, traction bronchiectasis | Most common ILD in RA, poor prognosis, resembles IPF |
| Non-Specific Interstitial Pneumonia (NSIP) | GGO, fine reticulation, subpleural sparing, no honeycombing | Better prognosis than UIP, more responsive to treatment | |
| Organizing Pneumonia (OP) | Patchy consolidation, peribronchovascular distribution, reverse halo sign | May mimic infection or malignancy; responsive to steroids | |
| Airway Disease | Follicular Bronchiolitis (Lymphocytic Bronchiolitis) | Centrilobular nodules, tree-in-bud, peribronchial thickening, occasional cysts | BALT hyperplasia; often coexists with LIP or RA-ILD |
| Bronchiectasis | Airway dilation, wall thickening, mucus plugging | Often associated with chronic inflammation or repeated infections | |
| Constrictive (Obliterative) Bronchiolitis | Mosaic attenuation, air trapping on expiratory imaging | Rare but serious; poor response to therapy; fixed airflow obstruction | |
| Pleural Disease | RA-associated Pleuritis | Pleural thickening, effusions (often exudative) | May be asymptomatic or present with chest pain; may calcify |
| Pleural Nodules or Masses | Focal pleural-based masses ± calcification | Consider RA, rheumatoid nodules, or malignancy | |
| Nodular Disease | Rheumatoid Nodules (parenchymal) | Round nodules, may cavitate; often multiple | Often in upper lobes; can mimic infection or neoplasm |
| Caplan Syndrome | Multiple rounded nodules + background pneumoconiosis | Seen in RA + occupational dust exposure (e.g., coal workers) | |
| Vascular Disease | Pulmonary Hypertension | Enlarged pulmonary arteries on CT | Can be secondary to ILD, vasculitis, or chron |
While joint disease is the primary presentation of rheumatoid arthritis, approximately 10-20% of patients present with pulmonary symptoms prior to joint symptoms.19 Pulmonary symptoms associated with RA include interstitial lung disease, pleural thickening or effusions, airway inflammation, pulmonary hypertension, and vasculitis, and confer significant morbidity and mortality.19 RA is more commonly associated with a UIP pattern, distinguishing it from the other connective tissue diseases which often present with NSIP. However, 10-30% of patients with RA will have a radiologic pattern of NSIP.19 Note the subpleural and basilar reticulation, minimal ground glass, traction bronchiectasis, honeycombing, and pleural thickening.
Patients often develop single or multiple rheumatoid nodules in the lung, which can range in size from a few millimeters to several centimeters.20 Rheumatoid nodules are often be located in the subpleural regions or along the interlobular septa.19- Rheumatoid Arthritis (RA)
While joint disease is the primary presentation of rheumatoid arthritis, approximately 10-20% of patients present with pulmonary symptoms prior to joint symptoms.19 Pulmonary symptoms associated with RA include interstitial lung disease, pleural thickening or effusions, airway inflammation, pulmonary hypertension, and vasculitis, and confer significant morbidity and mortality.19 RA is more commonly associated with a UIP pattern, distinguishing it from the other connective tissue diseases which often present with NSIP. However, 10-30% of patients with RA will have a radiologic pattern of NSIP.19 Note the subpleural and basilar reticulation, minimal ground glass, traction bronchiectasis, honeycombing, and pleural thickening.
Patients often develop single or multiple rheumatoid nodules in the lung, which can range in size from a few millimeters to several centimeters.20 Rheumatoid nodules are often be located in the subpleural regions or along the interlobular septa.19
