https://doi.org/10.4081/monaldi.2026.3869
High-resolution computed tomography imaging of pulmonary changes and relation with disease activity in rheumatoid arthritis
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Accepted: 14 October 2026
Published: 26 October 2026
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease with a wide spectrum of pulmonary manifestations, some of which may remain clinically occult. High-resolution computed tomography (HRCT) is an important imaging modality for detecting and characterizing these abnormalities. This study aimed to evaluate the spectrum of thoracic HRCT abnormalities in patients with RA and examine their association with disease activity and inflammatory markers. A prospective, analytical, hospital-based cross-sectional study was conducted from January 2021 to January 2022, including 63 adults with RA fulfilling the 2010 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria. Clinical characteristics, disease activity assessed using the Disease Activity Score 28-erythrocyte sedimentation rate (DAS28-ESR), inflammatory markers, and thoracic HRCT findings were recorded and analyzed. Of the 63 patients, 45 (71.4%) were women, and the mean age was 45.3±13.4 years. HRCT abnormalities were detected in 36 (57.1%) patients, with usual interstitial pneumonia-pattern interstitial lung disease (22.2%) and ground-glass opacities (19.0%) being the most frequent findings. Patients with abnormal HRCT findings had significantly higher DAS28-ESR scores, elevated erythrocyte sedimentation rates, and longer disease duration compared with those with normal HRCT findings (all p<0.001). C-reactive protein positivity (p<0.001) and anti-cyclic citrullinated peptide antibody positivity (p=0.012) were also significantly associated with HRCT abnormalities, whereas age and sex showed no significant associations. Pulmonary abnormalities detected by HRCT were common in patients with RA and were associated with greater disease activity, systemic inflammation, and longer disease duration. These findings highlight the importance of respiratory assessment in patients with RA, particularly those with active disease.
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Malaviya AN, Kapoor SK, Singh RR, et al. Prevalence of rheumatoid arthritis in the adult Indian population. Rheumatol Int 1993;13:131-4. DOI: https://doi.org/10.1007/BF00301258
Venetsanopoulou AI, Alamanos Y, Voulgari PV, Drosos AA. Epidemiology and Risk Factors for Rheumatoid Arthritis Development. Mediterr J Rheumatol 2023;34:404-13. DOI: https://doi.org/10.31138/mjr.301223.eaf
Turesson C, O'Fallon WM, Crowson CS, et al. Occurrence of extraarticular disease manifestations is associated with excess mortality in a community based cohort of patients with rheumatoid arthritis. J Rheumatol 2002;29:62-7.
Youssef AA, Machaly SA, El-Dosoky ME, El-Maghraby NM. Respiratory symptoms in rheumatoid arthritis: relation to pulmonary abnormalities detected by high-resolution CT and pulmonary functional testing. Rheumatol Int 2012;32:1985-95. DOI: https://doi.org/10.1007/s00296-011-1905-z
Li L, Gao S, Fu Q, et al. A preliminary study of lung abnormalities on HRCT in patients of rheumatoid arthritis-associated interstitial lung disease with progressive fibrosis. Clin Rheumatol 2019;38:3169-78. DOI: https://doi.org/10.1007/s10067-019-04673-4
Yin Y, Liang D, Zhao L, et al. Anti-cyclic citrullinated peptide antibody is associated with interstitial lung disease in patients with rheumatoid arthritis. PLoS One 2014;9:e92449. DOI: https://doi.org/10.1371/journal.pone.0092449
Rocha-Muñoz AD, Ponce-Guarneros M, et al. Anti-cyclic citrullinated peptide antibodies and severity of interstitial lung disease in women with rheumatoid arthritis. J Immunol Res 2015;2015:151626. DOI: https://doi.org/10.1155/2015/151626
Kelly CA, Saravanan V, Nisar M, et al. Rheumatoid arthritis-related interstitial lung disease: associations, prognostic factors and physiological and radiological characteristics--a large multicentre UK study. Rheumatology 2014;53:1676-82. DOI: https://doi.org/10.1093/rheumatology/keu165
Collins RL, Turner RA, Johnson AM, et al. Obstructive pulmonary disease in rheumatoid arthritis. Arthritis Rheum 1976;19:623-8. DOI: https://doi.org/10.1002/art.1780190316
Esposito AJ, Chu SG, Madan R, et al. Thoracic manifestations of rheumatoid arthritis. Clin Chest Med 2019;40:545-60. DOI: https://doi.org/10.1016/j.ccm.2019.05.003
Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010;69:1580-8. Erratum in: Ann Rheum Dis 2010;69:1892.
Zou YQ, Li YS, Ding XN, Ying ZH. The clinical significance of HRCT in evaluation of patients with rheumatoid arthritis-associated interstitial lung disease: a report from China. Rheumatol Int 2012;32:669-73. DOI: https://doi.org/10.1007/s00296-010-1665-1
Sabri YY, Taymour AT, Shaban MM, Kamel SF. The role of HRCT in evaluation of thoracic manifestations of rheumatoid arthritis. Egypt J Chest Dis Tuberc 2016;1:319-23. DOI: https://doi.org/10.1016/j.ejcdt.2015.10.007
Habib HM, Eisa AA, Arafat WR, Marie MA. Pulmonary involvement in early rheumatoid arthritis patients. Clin Rheumatol 2011;30:217-21. DOI: https://doi.org/10.1007/s10067-010-1492-5
Gabbay E, Tarala R, Will R, et al. Interstitial lung disease in recent onset rheumatoid arthritis. Am J Respir Crit Care Med 1997;156:528-35. DOI: https://doi.org/10.1164/ajrccm.156.2.9609016
Banik S, Tapadar SR, Ray A, Chaudhuri AD. A study of pulmonary manifestations of Rheumatoid Arthritis. J Clin Diagnostic Res 2018;12:5-9. DOI: https://doi.org/10.7860/JCDR/2018/30208.11625
Paulin F, Doyle TJ, Mercado JF, et al. Development of a risk indicator score for the identification of interstitial lung disease in patients with rheumatoid arthritis. Reumatol Clin 2021;17:207-211. [Article in English, Spanish]. DOI: https://doi.org/10.1016/j.reumae.2019.05.006
Samy N, Salah H, Hammoda RM. Rheumatoid arthritis patients with interstitial lung disease: Clinical, radiological and laboratory characteristics. Egypt Rheumatol 2021;43:29-34. DOI: https://doi.org/10.1016/j.ejr.2020.08.004
Qin Y, Wang Y, Meng F, et al. Identification of biomarkers by machine learning classifiers to assist diagnose rheumatoid arthritis-associated interstitial lung disease. Arthritis Res Ther 2022;24:115. DOI: https://doi.org/10.1186/s13075-022-02800-2
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