Usual interstitial pneumonia |
Basilar and peripheral traction bronchiectasis, with or without honeycombing Exuberant honeycombing, straight edge sign, and anterior upper lobe involvement |
Most common ILD pattern (60%) Worst prognosis among all ILD patterns |
Nonspecific interstitial pneumonia |
Basilar and peripheral ground-glass opacities and fine reticulation; traction bronchiectasis Usually symmetric Subpleural sparing may occur |
Association with longer duration of joint disease, lower risk of disease progression, and greater treatment response |
Organizing pneumonia |
Peripheral and peribronchovascular consolidation; ground-glass opacities Nodules and reversed halo sign may occur less frequently |
Abnormalities are often fleeting or migratory Usually has good prognosis |
Lymphocytic interstitial pneumonia |
Lower lobe-predominant and peribronchovascular thin-walled cysts Ground-glass opacities and septal thickening |
More commonly associated with Sjögren’s syndrome |
Desquamative interstitial pneumonia |
Ground-glass opacities and mild reticulation Cysts may be found Basal and peripheral predominance |
Rare and may precede the onset of RA by years |
Inflammatory pleural effusion |
Usually unilateral with small pleural enhancement |
Most patients are asymptomatic Usually exudative with low glucose levels, low pH levels, high LDH levels, high rheumatoid factor titers, low total complement activity, and low C3 and C4 levels |
Pulmonary arterial hypertension |
Enlarged pulmonary arteries, dilatation of right-sided cardiac chambers, and right ventricular hypertrophy Mosaic attenuation in the lungs as an indirect sign |
Rare and usually seen in older patients with long-standing RA-ILD |
Rheumatoid lung nodules |
Round opacities with variable size, usually multiple and cavitated Usually in the subpleural region |
Usually asymptomatic and associated with subcutaneous nodules |
Bronchiectasis |
Cylindrical, varicose, and cystic bronchiectasis may occur |
Chronic suppurative infections, treatment with disease-modifying antirheumatic drugs, and genetic predisposition may be related to bronchiectasis |
Constrictive bronchiolitis |
Bronchial wall thickening, bronchiectasis, and mosaic attenuation pattern |
More common in females and in those with long-standing untreated disease Airflow obstruction and air trapping in pulmonary function tests |
Follicular bronchiolitis |
Small centrilobular nodules with branching structures (tree-in-bud sign) Air trapping and peribronchovascular and septal thickening may also occur |
Associated with RA or Sjögren’s syndrome |
Caplan Syndrome (rheumatoid pneumoconiosis) |
Multiple peripheral lung nodules with cavitations or calcifications in some cases |
Associated with exposure to coal, asbestos, or silica May precede the onset of RA by more than 10 years Most patients are asymptomatic |
Lymphadenopathy |
Mediastinal or axillary |
Approximately 70% of patients with RA Patients may show signs of inflammatory activity |
Drug-induced lung disease |
Patterns suggestive of hypersensitivity pneumonitis, eosinophilic pneumonia, pulmonary edema, organizing pneumonia, and diffuse alveolar damage |
Secondary to immune-mediated reaction or direct toxicity Diagnosis usually based on symptoms, tomographic pattern, and time between treatment initiation and drug discontinuation Symptoms usually improve with drug discontinuation |