A 76 years old female comes to the emergency department because shortness of breath. She has been postrated since 2 months ago, when she wasn’t able to move her legs anymore. Shortness of breath since 1 week ago (NYHA IV). She states that she has “rheumas”. She gives no other information. She has been taking methotrexate since 4 years ago, in interval periods of time, she doesn’t know which doses. On physical examination you note a postrated elder woman with severe physical deformities. You also found this:
This is an extremely advanced case of rheumatoid arthritis. But, what associations with pulmonary disease does RA have? What kind(s) of pulmonary disease(s) does this patient have (or could have)?
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Excellent case, with some very nice radiographs. To address the question of the association of RA with pulmonary disease, the answer is that RA can be associated with several pulmonary manifestations. These span from rheumatoid nodules, to pleural effusions, to bronchiolitis-obliterans-organizing pneumonia, to interstitial lung diseases with the pathologic correlates of non-specific interstitial pneumonia or usual interstitial pneumonia.
Thas patient has radiographic changes with diffuse reticolonodular infiltrates and probably honeycombing in a predominantly sub-pleural distribution, which appears classic for UIP. This case is complicated by the prolonged treatment with Methotrexate which can, in itself, cause interstitial lung disease.
For those interested, further in-depth discussion of pulmonary and critical care medicine cases can be found at:
pulmonaryroundtable.blogspot.com
Thank you for the opinion Dr. Jeff.
We will check out The Pulmonary Round Table Blog.
Regards,
JonMikel, M.D.
I have just been isagnosised with interstitial pneumonia . What seems to be the treatment of choice? I see no FDA approved meds and steroids don’t seem to work. Immunical gama-1b is out there as well as lactoferrin (over the counter with some clinical trials) and stage 3 clinical trials of and another drug made by Actimmune….
Mike Watts, I really suggest you to visit The Pulmonary Round Table Blog where six specialists talk about pulmonary cases. You can submit your case or write them by email.
Best regards,
Jon