Abstract
Rheumatoid arthritis is a systemic inflammatory disorder that affects ∼1-2% of the population. Although a progressive destruction of cartilage and bone is the main presentation, extra-articular manifestations can occur in about 40% of patients during the course of their disease and are associated with significant morbidity and increased mortality. Pulmonary complications can frequently occur in these patients, although not always clinically recognized. We present a case of 60-year-old woman suffering from rheumatoid arthritis came to our department for the presence of exertional dyspnea, cough with poor mucous expectoration, chest pain and worsening of daytime asthenia. At a chest x-ray, evidence of right basal pulmonary atelectasis, for which she had practiced antibiotic therapy with persistence of symptomatology and pulmonary atelectasis. Chest CT showed parenchymal consolidation. The patient was treated with antibiotics and rehabilitation therapy, bronchial endoscopy, with persistence of pulmonary atelectasis. She started nasal high-flow therapy but in the seventh day appears epistaxis. For this reason, she suspended treatment with NHF. At the next rehabilitation session, for the recurrence of epistaxis, an otorhinolaryngology visit was performed that confirms the presence of nasal varices. Therefore, the patient started high-flow therapy with a mouthpiece with the use of High Frequency Chest Wall Oscillation. At the end of rehabilitative treatment we observed clinical and radiological improvement.
Highlights
It is well known that pulmonary manifestations are frequently associated with rheumatoid arthritis
Some authors emphasize on airway disease being one of the major risk factors of infection in rheumatoid arthritis patients and demonstrate that an obstruction of the peripheral airways could lead to respiratory failure [1]
High flow nasal cannula (HFNC) supportive therapy has emerged as a safe, useful therapy for prespiratory patient and improving oxygenation and comfort
Summary
It is well known that pulmonary manifestations are frequently associated with rheumatoid arthritis. Some authors emphasize on airway disease being one of the major risk factors of infection in rheumatoid arthritis patients and demonstrate that an obstruction of the peripheral airways could lead to respiratory failure [1]. Atelectasis is the collapse of lung tissue with loss of volume. The etiopathogenesis is commonly associated with a reduction of effective cough, mucus hypersecretion, poor hydration and a mucus plug that favors the stagnation of dense secretions. Treatment includes maintenance of effective cough, respiratory rehabilitation and removal of the cause when possible
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