高分辨率CT及积分在结缔组织病并发间质性肺炎及预后中的价值

目的 比较不同结缔组织病(CTD)并发间质性肺炎(ILD)的肺高分辨率CT(HRCT)影像学特征,探讨肺HRCT积分对判断患者预后的预测价值.方法 回顾性收集117例各类CTD 临床资料和影像学资料以及随访结果,对肺HRCT病变进行评分,研究肺HRCT积分与患者预后的关系.结果 117例CTD患者中有95例在肺HRCT上显示有ILD,其中,系统性红斑狼疮(SLE)34%,类风湿关节炎(RA)31%,多发性肌炎/皮肌炎(PM/DM)9%,成人斯蒂尔病(AOSD)9%,干燥综合征(SS)5%,系统性硬化症(SSc)7%,混合性结缔组织病(MCTD)5%.CTD并发ILD肺HRCT最常见的表现是小叶间隔增厚,其次为毛玻璃样变,之后依次为不规则线状影或胸膜下线、网格影、支气管血管束增厚、马赛克灌注、蜂窝肺、薄壁囊肿、结节灶、大片实变病变、肺大泡.AOSD和SSc患者纤维化积分显著高于渗出积分(P＜0.05);CTD并发ILD患者5年生存率为48.5%(95%可信区间为22.4%～67.9%),纤维化积分≥2分是预测患者预后不良的危险因素(P=0.032),其敏感性为82%,特异性为87%.结论 不同CTD并发的ILD有不同的影像学特征,肺HRCT可以较好地发现并鉴别,肺HRCT纤维化积分可以判断患者的预后.     

结缔组织病患者肺功能降低相关因素的探讨

目的旨在探讨结缔组织病(CTD)患者呼吸肌受损情况对肺通气功能、肺换气功能的影响。方法实验组选自CTD患者86例,其中系统性硬皮病(PSS)21例;系统性红斑狼疮(SLE)30例;皮肌炎(DM)35例。对照组20名均为体检健康自愿者。于入院后治疗前分别测定用力肺活量(FVC)、一秒率(FEV1.0/FVC)、峰流速(PEF)、一氧化碳弥散量(DLCO)、最大吸气压(PImax)、最大呼气压(PEmax)动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)。结果FVC、DLCO和PaO2CTD各组与对照组比较差异均有显著性(P<0.05~0.01);FEV1.0/FVCSLE组、DM组分别为69±9、54±13与对照组比较86±6差异有显著性(P<0.05~0.01);PEF:SLE组、DM组与对照组比较差异有非常显著性(P<0.01~0.05)。表明CTD各组均有限制性通气功能障碍和换气功能障碍。SLE组、DM组同时伴有阻塞性通气功能障碍。PImax:PSS组、SLE组和DM组分别为79±19、65±13、48±11与对照组93±17比较差异有显著性(P<0.05~0.01)。PEmax:PSS组、SLE组和DM组分别为37±9、35±10、23±10与对照组54±8比较差异有显著性(P<0.05~0.01)。结论提示CTD病人存在肺通气功能、肺换气功能障碍同时有呼吸肌受损,故考虑CTD病人肺功能降低除肺纤维化因素外还与呼吸肌受损因素有关。     

高分辨CT对结缔组织病所致肺间质病变的诊断价值

目的评价胸部高分辨率CT(HRCT)对早期发现结缔组织病所致肺间质病变的诊断价值。方法选择南京红十字医院及安徽医科大学附属医院2004年7月至2005年6月门诊及住院的系统性红斑狼疮患者20例、类风湿关节炎及干燥综合征患者共16例,行X线胸片及常规螺旋CT全胸扫描,运用HRCT对肺部扫描,进行对比分析。结果肺HRCT示21例(58.3%)患肺间质病变(ILD),常规螺旋CT示11例(30.6%)ILD,而X线全胸片仅4例(11.1%)示ILD。HRCT可见如蜂窝状阴影、胸膜下线影、小叶间隔增厚、毛玻璃样变等常规CT及X线胸片下无法观察到的征象。结论HRCT能充分显示肺间质纤维化的各种征象,对结缔组织病引起的肺间质病变的早期诊断有重要意义。     

继发于干燥综合征的间质性肺病21例临床分析

目的探讨继发于干燥综合征(Sjogren′s syndrome,SS)的间质性肺病(interstitial lung disease ILD)的诊断治疗方法。方法对21例继发于SS的ILD患者的临床表现、肺部X线、HRCT、肺功能、实验室检查及治疗情分析。结果本组继发于SS的ILD患者的主要临床症状为咳嗽、气促。肺部HRCT主要表现为肺容积缩小、网格影、毛玻璃影、胸膜下小叶间隔增厚、胸膜下弧线影、牵拉性小支气管扩张、胸膜增厚粘连,在诊断方面优于胸部X线。肺功能检测异常主要为弥散功能降低和限制性通气障碍。实验室检查多见血沉增快,自身抗体阳性,免疫球蛋白升高。经糖皮质激素单用或联合细胞毒性药物治疗,临床症状有改善。结论继发于SS的ILD的诊断主要包括:临床表现、肺功能、肺部影像学、相关实验室检查。糖皮质激素和细胞毒性药物对继发于SS的ILD患者有良好疗效。     

结缔组织病合并肺动脉高压及肺间质病变的肺功能分析

目的 比较和分析不同结缔组织病(CTD)相关肺部病变患者组间各项肺功能指标的差异.探讨肺功能检查对于评价CTD肺部病变性质和程度的临床意义.方法 前瞻性纳入CTD肺脏受累患者,根据肺部病变性质分为3组:CTD合并肺动脉高压组(CTD-PAH)29例、合并肺间质病变组(CTD-ILD))35例、合并PAH及ILD组(CTD-PAH+ILD)16例;另纳入无肺部病变的CTD患者34例作为对照组.比较各组间肺总量占预计值百分比(TLC%)、用力肺活量占预计值百分比(FVC%)、第1秒用力呼气量占预计值百分比(FEV_(1.0)%)、FEV_(1.0)/FVC、一氧化碳弥散量占预计值百分比(DLco%)、弥散率(DLco/VA)等主要肺功能指标的差异.结果 共114例患者纳入本研究,以女性多见,平均年龄35～39岁,易合并肺部病变的CTD依次为:混合性结缔组织病(MCTD)、系统性硬化症(SSc)、系统性红斑狼疮(SLE)和原发性干燥综合征(pSS).CTD-PAH组、CTD-ILD组和CTD-PAH+ILD组分别有10%、29%和46%的患者出现TLC下降;分别有50%、36%和71%的患者出现FVC%下降;分别有54%、47%和71%的患者出现FEV_(1.0)%下降;分别有100%、82%和100%的患者出现DLco%下降.多组间样本比较分析发现TLC%、FVC%、FEV_(1.0)%、DLco%在CTD对照组与CTD合并各肺部病变组之间的差异均有统计学意义(P＜0.05),而在CTD-ILD组与CTD-PAH组间差异均无统计学意义.TLC%在CTD-PAH组大于CTD-PAH+ILD组[(89±15)%与(79±12)%,P＜0.05)];FVC%在CTD-PAH组或CTD-ILD组均大于CTD-PAH+ILD组[(81±13)%、(80±16)%与(65±22)%,P＜0.05)].结论 肺功能检查对于筛查CTD合并的各种肺部病变具有临床应用价值,常表现为限制性通气功能障碍和弥散功能障碍,但从单次数值上无法鉴别CTD肺部病变种类(PAH与ILD).     

血清表面活性蛋白与系统性红斑狼疮合并间质性肺病的相关性研究

目的 探讨血清表面活性蛋白A(SP-A)和D(SP-D)与系统性红斑狼疮(SLE)合并间质性肺病(ILD)的相关性及其临床意义.方法 采用双抗体夹心酶联免疫吸附试验(ELISA)检测,并比较SLE组和对照组血清样本SP-A和SP-D水平的差异,分析其与SLE合并ILD的关系,判断与肺部高分辨率CT(HRCT)评分、肺功能、年龄、病情活动指标之间的相关性.结果 SLE组患者血清SP-A和SP-D水平高于健康对照组(P＜0.05).SLE组并发ILD患者血清SP-A和SP-D水平高于未合并ILD者以及对照组(P＜0.05).合并ILD的SLE患者血清SP-D水平与HRCT磨玻璃影评分(r=0.508,P=0.004)和间质病变评分(r=0.468,P=0.009)呈正相关关系,与肺活量(%VC)(r=-0.590,P=0.001)和一氧化碳弥散量(%DLCO)(r=-0.588,P＜0.01)呈负相关关系,而SP-A与上述指标无明显相关.SLE患者血清SP-D水平与年龄呈正相关关系(r=0.352,P=0.001).SLE-ILD组血清SP-D水平与血清IsG(r=0.376,P=0.040)呈正相关关系,SP-A水平与C反应蛋白(CRP)(r=0.403,P=0.027)呈正相关关系.结论 SP-D和SP-A是SLE并发ILD的血清学标志,SP-D与患者的HRCT评分、肺功能指标、年龄和病情活动度相关.     

几种弥漫性结缔组织病肺间质病变的影像分析

目的了解与弥漫性结缔组织病相关的肺间质病变（CTD—ILD）的发生率、影像学特征及其与病种和临床指标的相关性。方法回顾分析我院几种弥漫性结缔组织病患者（共412例）资料，X线胸片检查或有肺部临床症状患者作胸部高分辨CT（HRCT）进一步检查确诊。了解ILD在不同弥漫性CTD中的发生率，对比X线与HRCT的差异，统计常用CT分类在本组疾病中的分布比例．探讨CT分类与不同病种或临床特征之间的关系。结果在412例弥漫性结缔组织病中，HRCT诊断的ILD共40例，总发生率为9．7％。其中皮肌炎／多肌炎为25％，硬皮病为23．8％，原发性干燥综合征为9．6％，系统性红斑狼疮为6．3％。胸片与CT符合率40％，胸片误诊漏诊率60％。ILDCT分类以两种病变共存最多见，其中毛玻璃样变占40．1％，实变影32．8％，网格影16．4％，蜂窝状影9．8％。呼吸道症状和补体C3，C4水平在毛玻璃样变组及实变影组；C反应蛋白（CRP）水平在蜂窝状影和实变影组较其他对照组明显高，它们之间差异有统计学意义（P〈0．05）。结论HRCT发现CTD—ILD的敏感性及准确性明显优于X线，其中以毛玻璃及实变影最多见；影像学改变与呼吸道症状及炎症指标有一定关系，尽早进行HRCT的检查有助ILD的早期诊断及预后判断。     

多发性肌炎/皮肌炎合并间质性肺疾病的临床分析

目的探讨多发性肌炎/皮肌炎(PM/DM)合并间质性肺疾病(ILD)患者的临床表现、实验室检查、胸部影像学及肺功能的变化及意义。方法对住院的PM/DM并ILD患者7例(男性5例,女性2例,平均年龄55.7岁;5例为DM,2例为PM)均进行血清酶学和自身抗体测定、高分辨率CT(HRCT)及肺功能检查和皮肤肌肉活检。结果 6例患者出现酶学增高,以肌酸激酶(CK)和乳酸脱氢酶(LDH)增高明显;4例患者抗核抗体(ANA)(+),2例抗Jo-1抗体(+);皮肤肌肉活检病理诊断符合肌炎、皮肌炎改变。HRCT提示4例肺出现网点影及斑片阴影,3例出现双肺磨玻璃样病变和实变阴影。7例患者均出现限制性通气功能障碍,一氧化碳弥散量(DLCO)明显降低。6例患者使用糖皮质激素和免疫抑制剂治疗。5例患者治疗后病情稳定,1例患者死亡。结论 HRCT可以及早发现PM/DM肺部病变。CK明显增高和抗Jo-1抗体阳性是诊断DM/PM并ILD的重要指标。患者可出现严重的弥散功能低下,应用激素合并免疫抑制剂治疗可取得较好疗效。     

肿瘤坏死因子拮抗剂治疗结缔组织病相关肺间质病变的现状

肺间质病变(interstitial lung disease,ILD)是一组主要累及肺间质、肺泡和细支气管的疾病,可以是原发的,也可继发于多种疾病或药物,其中结缔组织病(connective tissue disease,CTD)是继发性ILD最常见和最重要的病因.可以引起ILD的CTD包括系统性硬化病、肌炎/皮肌炎、类风湿关节炎(rheumatoid arthritis,RA)、干燥综合征(SS)、系统性红斑狼疮(SLE)和混合性结缔组织病等.结缔组织病发生ILD的概率及病理类型与原发病相关,其中最常合并ILD的是系统性硬化病,其次为皮肌炎,而RA合并ILD的概率约为5%[1-4].     

皮肌炎多发性肌炎患者间质性肺病病理资料推断性分析

目的 分析皮肌炎(DM)、多发件肌炎(PM)合并间质性肺病(ILD)患者的胸部X线、胸部高分辨CT(HRCT)及肺功能等肺部表现临床特点及其预后.方法 回顾性分析上海长海医院风湿免疫科1999年1月至2007年1月期间收住院的33例DM/PM合并ILD除外感染患者的临床资料.结果 33例ILD患者经胸部X线及HRCT证实.根据临床-影像学特点并结合血气分析、肺功能测定,参照美国胸科学会和欧洲呼吸协会问质性肺炎的分类诊断标准,推断分析病理类型主要为非特异性间质性肺炎(NSIP)(57%)和寻常性间质性肺炎(UIP)(25%). UIP类型预后差、病死率高(70%).结论 结合患者的影像学资料、肺功能、血气分析推断病理类型主要为NSIP和UIP,其中UIP病死率高、预后差.     

Evaluation of interstitial lung disease in mixed connective tissue disease (MCTD)

OBJECTIVE: Interstitial lung disease (ILD) may be a characteristic, often serious, manifestation of mixed connective tissue disease (MCTD). In this retrospective study, the frequency and clinical picture of ILD were determined in patients with MCTD using two diagnostic tests: high-resolution computed tomography (HRCT) and inhaled aerosol clearance times of (99m)Tc-labelled diethylene-triamine pentaacetate ((99m)Tc-DTPA). In addition, pulmonary function, effects of therapy and a variety of immunoserological markers were also assessed. METHODS: One hundred and forty-four consecutive patients with MCTD were selected from the clinic, irrespective of the presence or absence of ILD. All patients underwent a detailed clinical assessment, chest HRCT scanning, chest radiography, inhaled aerosol of (99m)Tc-DTPA clearance times, and all pulmonary function tests. Patients who had active ILD received corticosteroid (CS) or CS in combination with cyclophosphamide (CPH). All investigations were repeated after 6 months of immunosuppressive therapy. RESULTS: Ninety-six out of 144 MCTD patients (66.6%) had active ILD, 75 of this group (78.1%) showed ground glass opacity, 21 patients (21.8%) ground glass opacity with mild fibrosis with HRCT. Forty-five patients with active ILD received 2 mg/kg/day CS for 6-8 weeks alone and 51 patients CS in combination with CPH (2 mg/kg/day). Six months later, after therapy, 67 out of 96 MCTD patients with ILD (69.8%) showed a negative HRCT pattern, ground glass opacity with mild fibrosis developed in 15 patients (15.6%), and fibrosis was detected in 13 patients (13.5%). Only one patient showed subpleural honeycombing. (99m)Tc-DTPA was rapid in all 96 MCTD patients with active ILD (28.7 +/- 8.2 min, normal value >40 min). After therapy the (99m)Tc-DTPA was normalized, 79 out of 96 patients (82.3%). Carbon monoxide diffusion capacity (DLCO) was reduced in 33 out of 96 MCTD patients with active ILD (34.3%), while there were no significant differences in the pulmonary function tests between the active versus inactive stage of ILD or versus patients without ILD. The sera of 96 MCTD patients with active ILD contained a high level of immune complexes (ICs), and the total haemolytic complement levels (CH50/ml U) decreased. After 6 months of therapy, the IC levels decreased and CH50/ml levels normalized (MCTD patients before and after active ILD: IC optical density = 355 +/- 227 vs 206 +/- 92, P<0.001; CH50/ml, 38.0 +/- 12.6 U vs 64.3 +/- 13.0 U, P<0.001). CONCLUSIONS: HRCT is the gold standard for diagnosis of ILD. However, we used another method, (99m)Tc-DTPA, in order to compare this technique with HRCT. This latter technique has not been studied previously in MCTD. The elevated levels of IC and increased complement consumption indicated that IC-mediated alveolocapillary membrane damage and tissue injury might play a role in the pathogenesis of ILD in MCTD.     

结缔组织病相关间质性肺病的诊治策略

结缔组织病(connective tissue disease,CTD)是一组全身性自身免疫性疾病,病变累及多种脏器。由于肺和胸膜均富含胶原、血管等结缔组织,因此 CTD 大多可以损伤肺和胸膜等呼吸系统多个器官,包括：呼吸肌、胸膜、肺血管、气道、肺实质和肺间质,且部分患者呼吸道表现为首发症状。间质性肺病(interstitial lung disease,ILD)在 CTD 中十分常见,发生率在数个 CTD 病种中超过50%。与之相对应,15%~30%初诊为特发型间质性肺炎(idiopathic interstitial pneumonia,IIP)的患者最终被确认符合 CTD-ILD 诊断。ILD 是导致 CTD 患者死亡的重要原因之一。CTD 包括包括系统性红斑狼疮(SLE)、类风湿性关节炎(RA)、原发性干燥综合征(pSS)、多发性肌炎(PM)、皮肌炎(DM)、系统性硬化(SSc)和混合性 CTD (MCTD)等。本文就 CTD-ILD 的诊治策略作一简要综述。     

结缔组织病相关肺动脉高压的临床分析

目的探讨结缔组织病(CTD)相关肺动脉高压(PAH)的临床、诊治和预后。方法回顾性分析北京协和医院1997年1月-2004年9月2189例CTD[包括混合性结缔组织病(MCTD)、系统性硬化(SSc)、原发性干燥综合征(pSS)、系统性红斑狼疮(SLE)、未分化结缔组织病(UCTD)、皮肌炎(DM)和白塞病(BD)]住院患者中并发PAH的临床和随访资料。结果(1)2189例CTD共发生PAH82例(3.7%),女75例,男7例,年龄12~71岁,平均41岁。PAH在SLE和MCTD患者中出现的时间(3年和2年)早于pSS患者(6年)。(2)主要临床表现是呼吸困难(84.1%)和肢端雷诺征(56.1%)。肺动脉收缩压(PASP)为(65.71±20.44)mmHg(1mmHg=0.133kPa),肺CO弥散量(DLCO)占预计值的百分比为(51±14)%,PaO2为(70.37±15.02)mmHg,PaCO2为(27.88±6.46)mmHg,PAH功能分级Ⅰ、Ⅱ、Ⅲ、Ⅳ级分别占13%、32%、29%、8%。(3)治疗后仅SLE患者PASP由(76.47±18.20)mmHg降至(69.08±20.77)mmHg。平均随访4.33年。82例并发PAH者13例(15.85%)死亡,明显高于未并发PAH的CTD患者的病死率(2.75%);死亡者与存活者相比,其PaO2更低,PAH功能分级Ⅲ、Ⅳ级的比例更多。结论CTD患者并发PAH不少见,一般在CTD发病后4年,SLE和MCTD并发PAH较早,pSS并发PAH较晚。CTD相关PAH的主要表现是呼吸困难和肢端雷诺征。严重PAH将影响CTD患者的预后,PAH功能分级或PaO2水平对预后评估有意义。定期对CTD患者行超声心动图和肺功能检查对筛查PAH非常必要。     

The Differing Patterns of Subclinical Pulmonary Involvement in Connective Tissue Diseases as Shown by Application of Factor Analysis

To explore common patterns of interstitial lung disease (ILD) in symptomless patients with connective tissue disease (CTD), we applied factorial analysis to determine the relationship among the factors. A selected cohort of 71 non-smoking patients with a confirmed diagnosis of CTD [24 with primary Sjo¨gren’s syndrome (pSS), 21 with systemic sclerosis (SS), 20 with rheumatoid arthritis (RA) and six with polymyositis/dermatomyositis (PM/DM)] were identified. The diagnostic techniques included pulmonary function tests, bronchoalveolar lavage (BAL), chest radiographs and high-resolution computed tomography (HRCT). Disease extent and severity were assessed by a radiological and HRCT grading system. Three factors, accounting for 67% of the total variance, were extracted. The first factor (disease duration, diffusing lung capacity, neutrophils and CD8+ T cells on BAL, radiographic score and HRCT reticular score), with the highest percentage of variance (36.5%), defines a fibrotic lung pattern. The second factor (17.9% of variance) identifies an inflammatory lung pattern (macrophages, lymphocytes and eosinophils on BAL and HRCT ground-glass score). The third factor (12.6% of variance) represents a ventilatory function pattern (forced vital capacity, total lung capacity and forced respiratory volume in 1 s). The negative correlation between the fibrotic lung pattern and ventilatory function pattern, but not with the inflammatory lung pattern, suggests the presence of a significant derangement of the alveolar structures. In conclusion, application of factor analysis reveals various lung disease patterns in patients with CTD that might have different prognostic implications. Received: 2 March 1999 / Accepted: 9 July 1999     

Interstitial lung disease in polymyositis and dermatomyositis: longitudinal evaluation by pulmonary function and radiology

OBJECTIVE: To estimate predictors and long-term outcome of interstitial lung disease (ILD) in patients with polymyositis (PM) and dermatomyositis (DM). METHODS: We conducted a prospective study in which newly diagnosed PM/DM patients, regardless of clinical symptoms of pulmonary disease, were investigated with repeated chest radiography, high-resolution computed tomography (HRCT) of the lungs, and pulmonary function test (PFT). Clinical, radiologic, and lung function outcome was based on the last followup results. RESULTS: Twenty-three patients with a mean followup period of 35 months were included. Findings on radiographic examination and/or PFT compatible with ILD were recorded in 18 patients (78%). Patients with ILD had lower lung function, higher radiologic scores, and higher creatine kinase values than those without ILD. All patients were treated with high-dose glucocorticoids and other immunosuppressive agents. Two patients died due to ILD, both with active myositis. During the followup, total lung capacity (TLC) improved in 33%, remained stable in 39%, and deteriorated in 28%. Changes in TLC correlated only partially with HRCT findings, which persisted even after normalizing for lung function. CONCLUSION: ILD associated with PM/DM is in most cases mild, chronic, and has a nonprogressive course during immunosuppressive treatment. PFT can be normalized during treatment with immunosuppressive therapy, even if radiologic signs of ILD persist. The course of ILD could not be predicted on the first examination. Therefore, myositis patients with ILD need careful evaluation of clinical features as well as PFT and radiologic features during followup.     

Short‐term and long‐term outcomes of interstitial lung disease in polymyositis and dermatomyositis: A series of 107 patients

Objective

This study was undertaken to assess the characteristics and outcome of interstitial lung disease (ILD) in polymyositis/dermatomyositis (PM/DM) and to determine variables predictive of ILD deterioration in PM/DM.

Methods

Among 348 consecutive patients with PM/DM, 107 patients with ILD were identified by medical records search in 4 medical centers. All patients underwent pulmonary function tests (PFTs) and pulmonary high‐resolution computed tomography (HRCT) scan.

Results

ILD onset preceded PM/DM clinical manifestations in 20 patients, was identified concurrently with PM/DM in 69 patients, and occurred after PM/DM onset in 18 patients. Patients with ILD could be divided into 3 groups according to their presenting lung manifestations: patients with acute lung disease (n = 20), patients with progressive‐course lung signs (n = 55), and asymptomatic patients with abnormalities consistent with ILD evident on PFTs and HRCT scan (n = 32). We observed that 32.7% of the patients had resolution of pulmonary disorders, whereas 15.9% experienced ILD deterioration. Factors that predicted a poor ILD prognosis were older age, symptomatic ILD, lower values of vital capacity and diffusing capacity for carbon monoxide, a pattern of usual interstitial pneumonia on HRCT scan and lung biopsy, and steroid‐refractory ILD. The mortality rate was higher in patients with ILD deterioration than in those without ILD deterioration (47.1% versus 3.3%).

Conclusion

Our findings indicate that ILD results in high morbidity in PM/DM. Our findings also suggest that more aggressive therapy may be required in PM/DM patients presenting with factors predictive of poor ILD outcome.

     

High-resolution CT and pulmonary function tests in rheumatoid arthritis patients with subclinical interstitial lung disease in Kuwait

BackgroundInterstitial lung disease (ILD) is a frequent extra-articular manifestation of RA and can cause significant morbidity and mortality.Aim of the workTo characterize and define the frequency of radiological and functional abnormalities capable of identifying “subclinical” RA-ILD with particular concern to the effect of methotrexate (MTX) therapy.Patients and methodsSixty patients with RA were recruited with no respiratory manifestations. They were classified into two groups: group 1 included 35 patients receiving MTX and group 2 included 25 patients receiving only nonsteroidal anti-inflammatory drugs. Patients were also classified according to chest high resolution CT (HRCT) as RA-ILD or RA-noILD. Pulmonary function test (PFT) abnormalities were also used to further characterize occult respiratory defects.Results38.3% of RA patients had subclinical ILD (25% in group 1 and 13.3% in group 2), while 61.7% were RA-no ILD. The percentage of patients with RA-ILD was insignificantly more in group 1 than group 2 (42.9% and 32% respectively). HRCT score revealed minimal to mild involvement in both groups. Long-standing RA with mean articular duration >50 months carries a significant risk for ILD. Other variables as age, gender, smoking, disease activity or rheumatoid factor seropositivity were not significant risk factors for development of RA-ILD.ConclusionsLung involvement should always be considered in patients with RA particularly those on MTX therapy even in the absence of chest symptoms. A tight control by PFTs, chest radiography and/or HRCT is necessary. Further studies evaluating the potential effect of MTX on progressive ILD with RA are needed.