HIGH-RESOLUTION COMPUTED-TOMOGRAPHY OF THE LUNG IN LIFELONG NONSMOKING PATIENTS WITH RHEUMATOID-ARTHRITIS

Objectives-To define pulmonary involvement on high resolution computed tomography (HRCT) of the thorax in lifelong non-smoking rheumatoid ar thritis patients and to relate the results to pulmonary function, bron chial reactivity, and a variety of clinical and serological factors . Methods-Twenty lifelong non-smoking RA patients (mean age 59 years (ra nge 44-72; 18 females) were studied. Detailed medical and drug histori es were taken, Protease inhibitor phenotype (Pi) and HLA-DR4 status we re assessed. Schirmer's tear tests were performed to detect keratoconj unctivitis sicca (KCS). Spirometry, flow volume loops, and gas factor measurement were The degree of bronchial reactivity (PC20 FEV(1)) was measured by a methacholine inhalation test. Chest and hand radiographs and HRCT of the lung were performed in all patients. Results-Thirteen patients were HLA-DR4 positive. Eighteen had the Pi MM and two the Pi MS phenotype. Eight patients had evidence of KCS on Schirmer's tear t esting. Ten patients achieved PC20 FEV(1) in the methacholine inhalati on test. All the patients had normal chest radiographs and all showed evidence of erosive arthropathy on hand radiographs. Five patients (25 %) showed basal bronchiectasis and one mild interstitial lung disease on HRCT. All five patients with bronchiectasis had the Pi MM phenotype , four had HLA-DR4, four had KCS and three achieved PC20 FEV(1); these values were not significantly different (p>0.05) from those in patien ts without bronchiectasis. Conclusion-Using the highly sensitive techn ique of HRCT, we found evidence to suggest that the incidence of bronc hiectasis lifelong non-smoking RA may be much higher than previously r eported.