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Clinical Rheumatology

, Volume 38, Issue 12, pp 3375–3380 | Cite as

High prevalence of abnormalities on chest radiography in rheumatoid arthritis

  • Michael R. Goggins
  • Richard ConwayEmail author
  • Laura J. Durcan
  • Ciaran Johnston
  • Gaye Cunnane
Original Article

Abstract

Introduction

Chest radiography (CXR) is commonly performed in rheumatoid arthritis (RA), particularly for the diagnosis of pulmonary disease. However, other structures are visible on CXR, abnormalities of which may contribute to morbidity and early mortality. This study was undertaken to evaluate the extent of CXR abnormalities in RA patients.

Methods

Consecutive out-patients meeting the 2010 ACR/EULAR classification criteria for RA were included. The most recent CXR was assessed by two independent reviewers. Abnormalities identified were recorded and compared to the formal CXR report. Predictors of abnormalities on CXR were assessed using chi-squared tests. SPSS 18.0 was used for statistical analysis.

Results

One hundred and ninety-eight patients were included. Mean age was 62 years (range 18–90). One hundred and nine (55.1%) were current or ex-smokers. One hundred and fifty-six (79%) patients were seropositive and 123 (62.1%) had joint erosions. A recent CXR was available in 163 (82%) cases. Abnormalities were identified in 129 (79.1%). Ninety-seven (60%) had bony abnormalities. Seventy-one (43.6%) had pulmonary abnormalities; old tuberculosis in 34 (20.9%), hyperinflation in 24 (14.7%), interstitial changes in 20 (13.3%), nodules in 4 (2.4%), consolidation in 2 (1.2%), and pneumothorax in 1 (0.6%). Cardiomegaly was identified in 37 (22.7%) and aortic calcification in 24 (14.7%). Age (p = 0.001), male gender (p = 0.01), and seropositivity (p = 0.04) were significantly associated with lung abnormalities. Cardiomegaly was associated with hypertension (p = 0.012) and ischaemic heart disease (p = 0.018).

Conclusion

Abnormalities were identified in 79% of chest radiographs in RA patients. Sixty-six percent of these were not reported. Clinicians need to be aware of the need to check for abnormalities.

Key Points

RA patients have a high prevalence of CXR abnormalities.

Many of these are of clinical significance.

Age, being male, and seropositivity were associated with lung abnormalities.

Keywords

Chest Radiography Rheumatoid arthritis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  1. 1.Department of RheumatologySt. James’s HospitalDublin 8Ireland
  2. 2.Department of RadiologySt. James’s HospitalDublin 8Ireland
  3. 3.Department of Clinical MedicineTrinity College DublinDublinIreland

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