Pulmonary Affection of Juvenile Idiopathic Arthritis Using High Resolution Computed Tomography: The Egyptian Experience

Background: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in pediatrics. Interstitial lung disease (ILD) is not uncommon among cases of JIA. However, it less frequently manifests clinically. High resolution computed tomography (HRCT)is the modality of choice for imaging of ILD. It commonly manifests initially as ground-glass opacity and evolves to septal thickening and pulmonary fibrosis. Objective: This study aimed to assess the pulmonary manifestations of patient with JIA and to correlate it with the findings on HRCT. Patients and methods: This cross-sectional study involved 30 JIA patients who were attending regularly at Rheumatology Clinic of Cairo University. Cases were assessed by complete history taking, general, articular, ophthalmological, chest examination and HRCT. Results: Out of 30 patients, 14 were males (46.7%) and 16 were females (53.3%) with female to male ratio of 1.1: 1. Pulmonary manifestation was reported in 14/30 JIA patients (46.7%) who presented with chronic cough, 11 of them (36.7%) was associated with sputum expectoration, 8 patients (26.7%) had additional wheezes while 4 patients (13.3%) had associated crepitation. Only 11/30 patients (36.7%) showed HRCT findings suspecting ILD. The most common finding was ground glass appearance in 9/ 30 patients (30%) followed by air trapping in 8/30 (26.7%), then interlobular thickening in 5 patients (16.7%). Only one patient presented with pulmonary nodule (3.3%). Out of 11 patients with positive HRCT findings, 5 patients had pulmonary manifestations (45.5%). There was no statistically significant relation between any of the pulmonary manifestations when compared with HRCT findings. Conclusion: Pulmonary complications of JIA are not uncommon and increasing in incidence. They are not necessarily associated with other specific clinical systemic or articular manifestations but they may be related to some types of biological treatment. HRCT findings of pulmonary complications in JIA patients are more common than clinically overt pulmonary manifestations. So, the routine use of HRCT is indicated for cases of JIA for early identification and proper treatment of any pulmonary complications.