PULMONARY-FUNCTION TESTS AND HIGH-RESOLUTION COMPUTED-TOMOGRAPHY OF THE LUNGS IN PATIENTS WITH RHEUMATOID-ARTHRITIS

Objective-To compare the results of pulmonary function tests (PFTs) an d high resolution computed tomography (HRCT) of the lungs in rheumatoi d arthritis (RA) patients. Methods-Sixty eight patients (54 women, 14 men) fulfilling the revised criteria for RE were consecutively include d in a transversal prospective study. Their mean age was 56.8 years (r ange: 35-82) and the mean duration of the disease was 12 years (range: 5-16), Rheumatoid factor was positive in 52 patients (76.5%). Fifty t wo patients (76.5%) were lifelong non-smokers. Detailed medical and dr ug histories were obtained. PFTs comprised spirometry and gas transfer measurements. Results for PFTs were expressed as percentage of predic ted values for each individual adjusted for age, sex, and height. HRCT was undertaken with a Siemens Somatom Plus. Results-A significant dec rease of FEV1/FVC, FEF25%, FEF50%, FEF75%, FEF25-75%, and TLCO was obs erved (p < 0.05) and 13.2% of the patients had a small airways involve ment defined by a decrease of FEF25-75% below 1.64 SD. The most freque nt HRCT findings were: bronchiectasis (30.5%), pulmonary nodules (28%) , and air trapping (25%). The patients with small airways involvement had a high frequency of recurrent bronchitis (75% v 34%, p = 0.05) and bronchiectasis (71% v 23%, p = 0.019). The patients with bronchiectas is were characterised by law values of FEV1, FVC, FEF25-75%, and TLCO (p < 0.01), a high prevalence of small airways involvement (29% v 5%, p = 0.019), and a low prevalence of HLA DQA1 0501 allele (14% v 33%, p < 0.05). Conclusion-This study suggests a significant association be tween small airways involvement an PFTs and bronchiectasis on HRCT in unselected RA patients.