High-resolution computed tomography imaging of pulmonary changes and relation with disease activity in rheumatoid arthritis

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.