Highresolution computed tomography ofthelung inlifelong non-smoking patients withrheumatoid

Objectives-To define pulmonary involvementonhighresolution computedtomography(HRCT)ofthethoraxinlifelong non-smoking rheumatoid arthritis patients andtorelate theresults topulmonaryfunction, bronchial reactivity, anda variety ofclinical andserological factors. Methods-Twenty lifelong non-smoking RA patients (meanage59years(range 44-72; 18females) werestudied. Detailed medicalanddrughistories weretaken. Proteaseinhibitor phenotype (Pi)and HLA-DR4 status were assessed. Schirmer's teartestswereperformed to detect keratoconjunctivitis sicca(KCS). Spirometry, flowvolumeloops, andgas transferfactormeasurement were recorded.The degreeof bronchial reactivity (PC20FEVy) wasmeasuredbya methacholine inhalation test. Chestand handradiographs andHRCT ofthelung wereperformed inallpatients. Results-Thirteen patients were HLADR4 positive. Eighteen hadthePiMM and two thePi MS phenotype. Eight patients had evidenceof KCS on Schirmer's teartesting. Ten patients achieved PC20FEV,inthemethacholine inhalation test.Allthepatients had normalchestradiographs andallshowed evidence oferosive arthropathy onhand radiographs. Fivepatients (25%)showed basalbronchiectasis andonemildinterstitial lungdisease on HRCT. Allfive patients withbronchiectasis hadthePi MM phenotype, fourhadHLA-DR4,four hadKCS andthreeachieved PC20FEV1; thesevalues werenotsignificantly different (p>0.05) from thosein patients without bronchiectasis. Conclusion-Using thehighlysensitive technique ofHRCT,wefoundevidence to suggestthattheincidence ofbronchiectasisin lifelong non-smokingRA patients may be much higherthan previously reported.