Patients With RA Show Changing Patterns of Pulmonary Abnormalities

Researchers studied the existing and changing patterns of pulmonary abnormalities among patients with rheumatoid arthritis.

Pulmonary abnormalities occur and change in several patterns in patients with rheumatoid arthritis (RA), suggesting that developmental pathways for these abnormalities, especially airway disease, may exist, according to study findings published in Respiratory Investigation.

Researchers in Japan conducted a retrospective cohort study among patients with RA to evaluate the preexisting and changing patterns of 20 different pulmonary abnormalities.

High-resolution computed tomography (CT) scans were studied prior to initiation of biologic therapy for RA. The scans were collected over an average follow-up period of 3.2 years.

Of the 208 patients with RA, 146 (70%) presented with pulmonary abnormalities, including interstitial lung disease (39%) and airway disease (55%), including bronchiolitis and bronchiectasis. Airway disease presented alone or in combination with other pulmonary abnormalities.

A total of 71 patients developed 115 new pulmonary abnormalities during the follow-up period compared with baseline. After initiation of biologic therapy, 42 preexisting pulmonary abnormalities worsened and 25 improved.

Among the 62 patients with RA without preexisting pulmonary abnormalities prior to biologic therapy, 11 (18%) developed 23 new abnormalities during the follow-up period. New abnormalities included bronchiolitis, curvilinear opacities, and bronchiectasis.

The researchers observed patterns between preexisting and new or worsening abnormalities.

At an individual level, new development of ground-glass opacity (GGO) strongly correlated with preexisting airway disease, honeycombing, and small nodular patterns.

At a regional level, new development of GGO also correlated with changing patterns of preexisting airway disease, reticular patterns, and small nodular patterns.

Study limitations included the retrospective design, varying follow-up periods for the patients based on physician discretion, small sample size, inclusion of only 20 of the 106 possible pulmonary abnormalities in RA, and the lack of accounting for possible confounding variables such as smoking status, production of autoantibodies, and type of RA treatment.

“Pulmonary abnormalities occurred and changed in several patterns, which suggests the existence of developmental pathways of pulmonary abnormalities,” the study authors said.” “[Airway disease] may play an important role in the development of these abnormalities, including GGO,” they added.

Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Tanaka A, Kurasawa K, Soda S, et al. Changing patterns of pulmonary abnormalities in rheumatoid arthritis. Respir Investig. Published online October 4, 2022. doi:10.1016/j.resinv.2022.09.002