Multiple pulmonary rheumatoid nodules
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Submission date: 2015-08-01
Final revision date: 2015-09-20
Acceptance date: 2015-09-22
Online publication date: 2015-12-08
Publication date: 2015-10-31
Reumatologia 2015;53(5):276–278
We present a case of 45-year-old female patient with the diagnosis of seropositive rheumatoid arthritis, who was admitted to our rheumatology department with exacerbation of the disease. The patient’s disease activity score (DAS 28) was 6.9. Physical examination revealed changes in the lung auscultation as a rough breathing sound at the middle and lower lobe of the right lung. Chest X-ray revealed multiple nodular densities in both lungs. Lung biopsy was performed for the diagnosis and revealed necrotizing granulomas with central fibrinoid necrosis surrounded by epithelioid cells. Such a histopathological picture is typical for rheumatoid nodules. Finally the patient was treated with rituximab, with significant improvement.
Turesson C, O’Fallon WM, Crowson CS, et al. Occurrence of extraarticular disease manifestations is associated with excess mortality in a community based cohort of patients with rheumatoid arthritis. J Rheumatol 2002; 29: 62-67.
Prete M, Racanelli V, Digiglio L, et al. Extra-articular manifestations of rheumatoid arthritis: an update. Autoimmun Rev 2011; 11: 123-131.
Nannini C, Ryu JH, Matteson EL. Lung disease in rheumatoid arthritis. Curr Opin Rheumatol 2008; 20: 340-346.
Gabriel SE, Crowson CS, Kremers HM, et al. Survival in rheumatoid arthritis: a population-based analysis of trends over 40 years. Arthritis Rheum 2003; 48: 54-58.
Turesson C, McClelland RL, Christianson TJ, Matteson EL. Multiple extra-articular manifestations are associated with poor survival in patients with rheumatoid arthritis. Ann Rheum Dis 2006; 65: 1533-1534.
Sihvonen S, Korpela M, Laippala P, et al. Death rates and causes of death in patients with rheumatoid arthritis: a population-based study. Scand J Rheumatol 2004; 33: 221-227.
Lioté H. Pulmonary manifestation of rheumatoid arthritis. Rev Mal Respir 2008; 25: 973-988.
Yousem SA, Colby TV, Carrington CB. Lung biopsy in rheumatoid arthritis. Am Rev Respir Dis 1985; 131: 770-777.
Fellbaum C, Domej W, Popper H. Rheumatoid arthritis with extensive lung lesions. Thorax 1989; 44: 70-71.
Ziff M. Rheumatoid nodule. Arthritis Rheum 1990; 33: 761-767.
Braun MG, Wagener P. Regression of peripheral and pulmonary rheumatoid nodules under therapy with rituximab. Z Rheumatol 2013; 72: 166-171.
Andres M, Vela P, Romera C. Marked improvement of lung rheumatoid nodules after treatment with tocilizumab. Rheumatology (Oxford) 2012; 51: 1132-1134.
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