Abstract
A 69 year-old man presented with interstitial pneumonia associated with rheumatoid arthritis (RA). About 7 months before the appearance of signs of arthritis, his chest roentgenogram showed interstitial shadows. Serological examination at that time already revealed high titers of antinuclear antibody and rheumatoid factor. The high-resolution chest CT showed a pattern of interstitial pneumonia with patchy thickening of the pleura. Bronchoalveolar lavage revealed increases in neutrophils and lymphocytes, suggesting nonusual interstitial pneumonia. Transbronchial biopsy showed a histopathologic pattern of fibrotic nonspecific interstitial pneumonia. On admission, the patient suffered persistent arthritis in multiple joints, consistent with RA. At that time, lung involvement preceding RA was diagnosed. Clinically, it is important to differentiate interstitial pneumonia associated with collagen vascular disease (CVD-IP) from idiopathic interstitial pneumonias (IIPs), because prognosis and treatment of these two diseases is different. However, a patient may sometimes present the clinical features of IIPs and later develop a defined connective tissue disease. Therefore, it is always necessary to consider the possibility of CVD-IP when following patients with IIPs.
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