Tomographic pleuropulmonary manifestations in rheumatoid arthritis: a pictorial essay

Rheumatoid arthritis (RA) is an autoimmune inflammatory and heterogeneous disease that affects several systems, especially the joints. Among the extra-articular manifestations of RA, pleuropulmonary involvement occurs frequently, with different presentations, potentially in all anatomic thoracic com...

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Published in:Jornal brasileiro de pneumologia 2023-01, Vol.49 (1), p.e20220466-e20220466
Main Authors: Bridi, Guilherme das Posses, Sawamura, Márcio Valente Yamada, Wanderley, Mark, Souza, Luciana Volpon Soares, Kairalla, Ronaldo Adib, Kawano-Dourado, Letícia, Baldi, Bruno Guedes
Format: Article
Language:English
Subjects:
Arthritis, rheumatoid
Arthritis, Rheumatoid - complications
Arthritis, Rheumatoid - diagnostic imaging
Autoantibodies
Humans
Lung
Lung diseases
Lung diseases, interstitial
Lung Diseases, Interstitial - diagnostic imaging
Lung Diseases, Interstitial - etiology
Male
Pictorial
Pleural diseases
Pulmonary arterial hypertension
RESPIRATORY SYSTEM
Risk Factors
Tomography
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Summary:Rheumatoid arthritis (RA) is an autoimmune inflammatory and heterogeneous disease that affects several systems, especially the joints. Among the extra-articular manifestations of RA, pleuropulmonary involvement occurs frequently, with different presentations, potentially in all anatomic thoracic compartments, and may determine high morbidity and mortality. The most common pleuropulmonary manifestations in patients with RA include interstitial lung disease (ILD), pleural disease, pulmonary arterial hypertension, rheumatoid lung nodules, airway disease (bronchiectasis and bronchiolitis), and lymphadenopathy. Pulmonary hypertension and ILD are the manifestations with the greatest negative impact in prognosis. HRCT of the chest is essential in the evaluation of patients with RA with respiratory symptoms, especially those with higher risk factors for ILD, such as male gender, smoking, older age, high levels of rheumatoid factor, or positive anti-cyclic citrullinated peptide antibody results. Additionally, other etiologies that may determine tomographic pleuropulmonary manifestations in patients with RA are infections, neoplasms, and drug-induced lung disease. In these scenarios, clinical presentation is heterogeneous, varying from being asymptomatic to having progressive respiratory failure. Knowledge on the potential etiologies causing tomographic pleuropulmonary manifestations in patients with RA coupled with proper clinical reasoning is crucial to diagnose and treat these patients.
ISSN:1806-3756
1806-3713
1806-3756
DOI:10.36416/1806-3756/e20220466