The Warrick score for the evaluation of chest CT scan manifestations of rheumatoid arthritis

Introduction: Thoracic involvement during rheumatoid arthritis (RA) often requires several investigations including thoracic CT scans which had greatly improved the approach to the rheumatoid lung. Aim of study: assess thoracic involvement in RA using a radiological score. Method: A two-year retrospective study including the records of patients followed for RA with pleuro-pulmonary involvement. All patients had a high-resolution thoracic CT scan. Diffuse interstitial lung disease was assessed by the Warrick score composed of two parts: disease severity score (quotation of 5 types of elementary lesions) and disease extend score (number of segments involved). Results: 24 records were enrolled (Average age=59years; sex-ratio F/H=1.66). The diagnosis of RA was done in average since 8 years. Seventeen patients received Methotrexate®, 6 Salazopyrine®, 2 Palquenil® and 1 Imurel®. In thoracic CT scan there were nodules in 29% of cases, bronchiectasis in 25%, ground-glass opacities in 42%, septal and subpleural lines in 42%, honeycombing in 12%, constrictive bronchiolitis in 8% and emphysema in 17%. The average FVC was 2.48l/min(72%), FEV1 was 1.78l/min(70%) and TPC was 4.14l/min(81%). The average of severity score was 6.4, its of disease extend 8.3 and the Warrick score was 14.7. The disease severity score was higher in the patient receiving Imurel®(10 vs 6;p=0.068) and Salazopyrine®(8 vs 5; p=0.015). FVC was inversely correlated to ground-glass opacities in CT scan (60% vs 76%;p=0.022), to honeycombing (53% vs 74%;p=0.048) and to septal and subpleural lines (62% vs 79%;p=0.022). Conclusion: The Warrick score is a good tool for predicting the severity of RA which will require second line treatment