High prevalence of abnormalities on chest radiography in rheumatoid arthritis
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.
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.
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).
• 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.
KeywordsChest Radiography Rheumatoid arthritis
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.
- 2.Conway R, Carey JJ (2016) Methotrexate and lung disease in rheumatoid arthritis. Panminerva Med. https://doi.org/10.23736/S0031-0808.16.03260-2
- 7.(2005) BTS recommendations for assessing risk and for managing Mycobacterium tuberculosis infection and disease in patients due to start anti-TNF-alpha treatment. Thorax. 60(10):800–805. https://doi.org/10.1136/thx.2005.046797
- 8.Ledingham J, Gullick N, Irving K, Gorodkin R, Aris M, Burke J, Gordon P, Christidis D, Galloway S, Hayes E, Jeffries A, Mercer S, Mooney J, van Leuven S, Galloway J, on behalf of the BSR and BHPR Standards, Guidelines and Audit Working Group (2017) BSR and BHPR guideline for the prescription and monitoring of non-biologic disease-modifying anti-rheumatic drugs. Rheumatology (Oxford) 56(6):865–868. https://doi.org/10.1093/rheumatology/kew479 CrossRefGoogle Scholar
- 12.Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd et al (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 69(9):1580–1588. https://doi.org/10.1136/ard.2010.138461 CrossRefGoogle Scholar
- 13.Smolen JS, Landewe R, Breedveld FC, Buch M, Burmester G, Dougados M et al (2014) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 73(3):492–509. https://doi.org/10.1136/annrheumdis-2013-204573 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Gross RL, Schwartzman-Morris JS, Krathen M, Reed G, Chang H, Saunders KC, Fisher MC, Greenberg JD, Putterman C, Mease PJ, Gottlieb AB, Kremer JM, Broder A (2014) A comparison of the malignancy incidence among patients with psoriatic arthritis and patients with rheumatoid arthritis in a large US cohort. Arthritis Rheumatol 66(6):1472–1481. https://doi.org/10.1002/art.38385 CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Mader R, Verlaan JJ, Eshed I, Jacome BA, Puttini PS, Atzeni F, Buskila D, Reinshtein E, Novofastovski I, Fawaz A, Kurt V, Baraliakos X (2017) Diffuse idiopathic skeletal hyperostosis (DISH): where we are now and where to go next. RMD Open 3(1):e000472. https://doi.org/10.1136/rmdopen-2017-000472 CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Fuchs HA, Kaye JJ, Callahan LF, Nance EP, Pincus T (1989) Evidence of significant radiographic damage in rheumatoid arthritis within the first 2 years of disease. J Rheumatol 16(5):585–591Google Scholar