Airways Abnormalities in a Prospective Cohort of Patients With Rheumatoid Arthritis

Area of Science:

• Pulmonary Medicine
• Rheumatology
• Radiology
• Medical Imaging

Background:

• Rheumatoid arthritis (RA) affects approximately 1% of the population, frequently involving the lungs.
• While interstitial lung disease (ILD) in RA is recognized, airways disease remains understudied.
• This study investigates baseline airway abnormalities in RA patients without diagnosed ILD.

Purpose of the Study:

• To assess baseline airway abnormalities in a prospective rheumatoid arthritis (RA) cohort.
• To correlate these abnormalities with pulmonary function testing (PFT) and high-resolution CT (HRCT) findings.
• To explore associations between airway disease and respiratory symptoms in RA patients.

Main Methods:

• 188 RA patients without ILD underwent HRCT imaging and PFT.
• Radiologists evaluated HRCT scans for airway abnormalities.
• Computational imaging (VIDA Vision) and quantitative CT analysis were used to quantify airway abnormalities in 147 patients.

Main Results:

• Airways obstruction (FEV1/FVC < 0.7) was found in 20.7% of patients, associated with older age, male sex, and smoking.
• Radiologists detected airway abnormalities in 61% of patients, including bronchial wall thickening (55%) and bronchiectasis (12%).
• Quantitative CT metrics correlated with PFT obstruction and more severe respiratory symptoms like shortness of breath and cough.

Conclusions:

• High rates of airway abnormalities were detected in this RA cohort using multiple methods.
• Quantitative CT measures showed significant associations with respiratory symptoms.
• Airways disease may be an underrecognized extra-articular manifestation of RA, detectable by quantitative CT imaging.