Detection of Lung Abnormalities in Patients With Rheumatoid Arthritis Who Smoke and Who Were Screened for Lung Cancer With Low-Dose Chest Computed Tomography Imaging in Routine Clinical Care: Results From a Large Multihospital System.

OBJECTIVE

Rheumatoid arthritis (RA) is associated with interstitial lung disease, bronchiectasis, rheumatoid lung nodules, and lung cancer. Recent guidelines proposed criteria for lung disease screening in RA, but the prevalence of abnormal lung findings in patients with RA is unknown.

METHODS

Among all patients screened for lung cancer with low-dose chest computed tomography (CT) in the Mass General Brigham health care system between 2015 and 2023, we identified patients with and without RA. We compared the prevalence of lung nodules, "positive screen" (nodules requiring further imaging or biopsy), fibrotic lung changes, bronchiectasis, and lung cancer between patients with RA and comparators without RA using multivariable logistic regression.

RESULTS

Among consecutive patients screened for lung cancer with clinically indicated low-dose chest CT, we identified 228 patients with RA and 14,805 comparators without RA. "Positive screens" were noted in 26.8% of patients with RA and 22.2% of patients without RA (P = 0.10). Lung cancer was found in 4.8% of patients with RA and 3.6% of patients without RA (P = 0.33). In multivariable models, RA was associated with positive screen (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.02-1.87), fibrotic lung changes (OR 1.77, 95% CI 1.08-2.91), and bronchiectasis (OR 1.64, 95% CI 1.12-2.39).

CONCLUSION

Patients with RA had higher prevalence of positive screening, fibrotic changes, and bronchiectasis detected by low-dose chest CT performed for lung cancer screening. Approximately one in four patients with RA who met US Preventive Services Task Force lung cancer screening criteria had a positive screen, whereas 1 in 20 had lung cancer. These results emphasize the importance of lung cancer screening among eligible patients with RA and may inform screening strategies for other lung abnormalities.