Interstitial Lung Disease as the Initial Manifestation of Rheumatoid Arthritis: A Case Report and Review of the Literature.

Kurnvir Singh,Khaleda Akter,Mohammed Al-Sadawi,Romy Rodriguez Ortega,Tomasz Zrodlowski,Isabel M Mcfarlane,Claudia Zmijewski

doi:10.12691/ajmcr-7-12-10

Kurnvir Singh, Khaleda Akter + Show 5 more

Open Access

https://doi.org/10.12691/ajmcr-7-12-10

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Abstract

Background: Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disorder that primarily affects synovial joints. Approximately 18–41% of patients with RA develop extra-articular manifestations [1]. However, extra-articular manifestations preceding or occurring without articular symptoms in RA have rarely been reported. Such atypical presentations of RA pose a diagnostic challenge to the clinician and may delay treatment. Case presentation: A 57-year-old female with long standing diabetes, hypertension, hyperlipidemia and Raynaud’s phenomenon presented shortness of breath, cough and new subcutaneous nodules. Four years before, she had been diagnosed with non specific interstitial pneumonia but had declined treatment. The physical exam did not reveal any signs suggestive of RA however, she was seropositive for rheumatoid factor (RF) and anti-citrullinated peptide antibody (ACPA). Treatment for RA-associated interstitial lung disease was discussed. Conclusion: Extra-articular involvement of RA can be observed as initial presentation of the disease in a handful of cases. However, RA diagnosis must be achieved to correctly manage these patients which can at that time receive targeted therapeutic interventions. From our literature review, pulmonary involvement was seen in over half of the cases in seropositive RA patients who lacked articular involvement at initial presentation.

Highlights

Rheumatoid Arthritis (RA) is a progressive systemic inflammatory disorder with a prevalence of 1% among Black population characterized by proliferating synovitis and erosive destruction of cartilage and bone [2]
The most common subtype of interstitial lung disease (ILD) in Rheumatoid arthritis (RA) is the usual interstitial pneumonia followed by the non-specific interstitial pneumonia (NSIP) pattern, organizing pneumonia, desquamative interstitial pneumonia lymphocytic interstitial pneumonia and diffuse alveolar damage have been documented [12,13]
A recent study of our RA patient population revealed that UIP was the common pattern affecting mainly women with a mean age of 62.6 years of age, with smoking history found in only 31% of the cases

Summary

Introduction

Rheumatoid Arthritis (RA) is a progressive systemic inflammatory disorder with a prevalence of 1% among Black population characterized by proliferating synovitis and erosive destruction of cartilage and bone [2]. Given that RA is systemic disease, a number of. Extra-articular manifestations in RA, can be be present including involvement of the cardiovascular, pulmonary, cutaneous, gastrointestinal, neurological, ophthalmological, renal and vascular systems [1,3]. Extra-articular manifestations in RA occur in about 18–41% of patients and may precede the onset of articular manifestations [1,4]. Diagnosis and initiation of disease modifying anti-rheumatic drugs (DMARD) therapy is critical to delay or prevent further progression of RA [3]. Atypical manifestations could challenge the diagnosis of RA and subsequently lead to a delay in management

Case Presentation

Findings

Discussion and Literature