Gautam Mahesh, Masood Mah Jabeen, Arooj Sadaf, Mahmud Mufazzal-E-Haque, Mukhtar Muhammad Umer
Radiology, Nobel Medical College, Biratnagar, NPL.
Radiology, King Edward Medical University, Lahore, PAK.
Cureus. 2020 Feb 4;12(2):e6875. doi: 10.7759/cureus.6875.
Background and aim Rheumatoid arthritis (RA) is a chronic inflammatory systemic disease characterized by bilateral involvement of mostly small joints of hands and feet. There can be various extra-articular manifestations of the disease including lung parenchymal disease. Pulmonary involvement in RA patients leads to increased morbidity and mortality. The overall burden of RA related pulmonary disease is underestimated due to the limitation of resources in underdeveloped countries. High-resolution computed tomography (HRCT) is an important tool used to diagnose different abnormalities in RA related interstitial lung disease (ILD). The objective of the study was to evaluate HRCT findings in patients of RA related ILD and categorize the radiological findings according to clinical findings. Method This descriptive prospective observational study was conducted at Mayo Hospital, Lahore from June 2014 to June 2015. Patients of RA suspected of lung disease after selection underwent HRCT chest on 128-slice Hitachi CT scanner (Hitachi Global, Tokyo, Japan) in the radiology department. Images were reconstructed and evaluated by experienced radiologists. Findings were recorded on a questionnaire. Data was analyzed on SPSS version 21 (IBM Corp, Armonk, US). Results Out of the 54 patients scanned, interlobular septal thickening was the most common finding found in 22 of the patients. Ground-glass opacification was recognized in 21 patients, honeycombing in nine and bronchiectasis in two patients. Regarding zonal predilection of disease pattern, lower zones of lungs were found involved in most of the cases. The disease was found to be bilateral in 15 patients. Based on these findings, usual interstitial pneumonitis (UIP) was diagnosed in six patients and non-specific interstitial pneumonitis (NSIP) in 14 others. Conclusion This study concluded that HRCT images are very useful in diagnosing interstitial lung disease related to rheumatoid arthritis.
背景与目的 类风湿关节炎（RA）是一种慢性炎症性全身性疾病，其特征为双手和双脚的大多数小关节双侧受累。该疾病可有多种关节外表现，包括肺实质疾病。RA患者的肺部受累会导致发病率和死亡率增加。由于欠发达国家资源有限，RA相关肺部疾病的总体负担被低估。高分辨率计算机断层扫描（HRCT）是用于诊断RA相关间质性肺病（ILD）中不同异常的重要工具。本研究的目的是评估RA相关ILD患者的HRCT表现，并根据临床发现对放射学表现进行分类。方法 本描述性前瞻性观察性研究于2014年6月至2015年6月在拉合尔的梅奥医院进行。入选后怀疑有肺部疾病的RA患者在放射科使用128层日立CT扫描仪（日立全球，东京，日本）进行胸部HRCT检查。图像由经验丰富的放射科医生重建和评估。结果记录在问卷上。数据在SPSS 21版（IBM公司，阿蒙克，美国）上进行分析。结果 在54例接受扫描的患者中，小叶间隔增厚是最常见的表现，在22例患者中发现。21例患者出现磨玻璃影，9例出现蜂窝状改变，2例出现支气管扩张。关于疾病模式的区域偏好，大多数病例发现肺部下叶受累。15例患者发现疾病为双侧性。基于这些发现，6例患者被诊断为寻常型间质性肺炎（UIP），14例被诊断为非特异性间质性肺炎（NSIP）。结论 本研究得出结论，HRCT图像在诊断类风湿关节炎相关间质性肺病方面非常有用。
