Interstitial lung disease as an extra-articular manifestation of rheumatoid arthritis: a case report
Abstract
Aim: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease. It occurs in 1 % of the population. It causes joint and extra-articular damage. The lung is the second extra-articular organ most affected. Risk factors for poor prognosis in rheumatoid arthritis associated with interstitial lung disease (RA-ILD) are: pneumonia, smoking, and advanced age. Computerized Tomography (CT) is the most widely used imaging method for diagnosis. Therefore, we aimed to present the unusual clinical behavior of rheumatoid arthritis when it compromises lungs in the presence of factors that favor the progression of the disease.
Case report: We present the case of an 87-year-old chronic ex-smoker patient with rheumatoid arthritis diagnosed 1 year ago. Pulmonary damage was documented by imaging studies where interstitial disease and superinfection were reported causing continuous hospital admissions and relating dyspnea as the main symptom. A successful control of the symptoms was achieved by indicating antirheumatic treatment, corticosteroids, and broad-spectrum antibiotic coverage.
Conclusions: In patients with antirheumatic management, we report a patient with an unusual behavior of spontaneous (short-term) remission of RA for developing lung damage in the presence of risk factors that favor the progression of the disease.
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References
Jönsson E, Ljung L, Norrman E, Freyhult E, Ärlestig L, Dahlqvist J, et al. Pulmonary fibrosis in relation to genetic loci in an inception cohort of patients with early rheumatoid arthritis from northern Sweden. Rheumatology (Oxford). 2022;61(3):943-52. DOI: https://doi.org/10.1093/rheumatology/keab441
Azam AT, Odeyinka O, Alhashimi R, Thoota S, Ashok T, Palyam V, et al. Rheumatoid arthritis and associated lung diseases: A comprehensive review. Cureus [Internet]. 2022;14(2):e22367. DOI: http://dx.doi.org/10.7759/cureus.22367
Orozco BJD, Imbachí SAJ, Ospina AI. Manifestaciones pulmonares de la artritis reumatoide, una revisión en tiempos de pandemia por SARS-CoV-2. Rev. Colomb. Reumatol. 2021;29(1):56-65. DOI: http://dx.doi.org/10.1016/j.rcreu.2020.12.005
Mena-Vázquez N, Rojas-Gimenez M, Romero-Barco CM, Manrique-Arija S, Francisco E, Aguilar-Hurtado MC, et al. Predictors of progression and mortality in patients with prevalent rheumatoid arthritis and interstitial lung disease: A prospective cohort study. J. Clin. Med. 2021;10(4):874. DOI: http://dx.doi.org/10.3390/jcm10040874
Kim HC, Choi KH, Jacob J, Song JW. Prognostic role of blood KL-6 in rheumatoid arthritis-associated interstitial lung disease. PLoS One. 2020;15(3):e0229997. DOI: https://doi.org/10.1371/journal.pone.0229997
Fu Q, Wang L, Li L, Li Y, Liu R, Zheng Y. Risk factors for progression and prognosis of rheumatoid arthritis-associated interstitial lung disease: single center study with a large sample of Chinese population. Clin Rheumatol. 2019;38(4):1109-16. DOI: https://doi.org/10.1007/s10067-018-4382-x
Kakutani T, Hashimoto A, Tominaga A, Kodama K, Nogi S, Tsuno H, et al. Related factors, increased mortality and causes of death in patients with rheumatoid arthritis-associated interstitial lung disease. Mod Rheumatol. 2020;30(3):458-64. DOI: https://doi.org/10.1080/14397595.2019.1621462
Zamora-Legoff JA, Krause ML, Crowson CS, Ryu JH, Matteson EL. Patterns of interstitial lung disease and mortality in rheumatoid arthritis. Rheumatology (Oxford). 2017;56(3):344-50. DOI: https://doi.org/10.1093/rheumatology/kew391
Robles-Pérez A, Luburich P, Bolivar S, Dorca J, Nolla JM, Molina-Molina M, et al. A prospective study of lung disease in a cohort of early rheumatoid arthritis patients. Sci Rep. 2020;10(1):15640. DOI: https://doi.org/10.1038/s41598-020-72768-z
Yamakawa H, Sato S, Nishizawa T, Kawabe R, Oba T, Kato A, et al. Impact of radiological honeycombing in rheumatoid arthritis-associated interstitial lung disease. BMC Pulm Med. 2020;20(1):25. DOI: https://doi.org/10.1186/s12890-020-1061-x
Torun S, Karaman I. Acute exacerbation of rheumatoid arthritis misdiagnosed as COVID-19: A case report. Front Med (Lausanne). 2022;9:844609. DOI: https://doi.org/10.3389/fmed.2022.844609
Koch MC, Pereira IA, Nobre LFS, Neves FS. Computed tomography of pulmonary changes in rheumatoid arthritis: carcinoembryonic antigen (CEA) as a marker of airway disease. Rheumatol Int. 2016;36(4):531-9. DOI: http://dx.doi.org/10.1007/s00296-016-3438-y
Martinez FJ, Collard HR, Pardo A, Raghu G, Richeldi L, Selman M, et al. Idiopathic pulmonary fibrosis. Nat Rev Dis Primers. 2017;3(1):17074. DOI: https://doi.org/10.1038/nrdp.2017.74
Panagopoulos P, Goules A, Hoffmann-Vold AM, Matteson EL, Tzioufas A. Natural history and screening of interstitial lung disease in systemic autoimmune rheumatic disorders. Ther Adv Musculoskelet Dis. 2021;13:1759720X211037519. DOI: https://doi.org/10.1177/1759720X211037519
Saku A, Fujisawa T, Nishimoto K, Yoshimura K, Hozumi H, Karayama M, et al. Prognostic significance of peripheral blood monocyte and neutrophil counts in rheumatoid arthritis-associated interstitial lung disease. Respir Med. 2021;182:106420. DOI: https://doi.org/10.1016/j.rmed.2021.106420
Salaffi F, Carotti M, Di Carlo M, Tardella M, Giovagnoni A. High-resolution computed tomography of the lung in patients with rheumatoid arthritis: Prevalence of interstitial lung disease involvement and determinants of abnormalities. Medicine. 2019;98(38):e17088. DOI: http://dx.doi.org/10.1097/MD.0000000000017088
Singh N, Varghese J, England BR, Solomon JJ, Michaud K, Mikuls TR, et al. Impact of the pattern of interstitial lung disease on mortality in rheumatoid arthritis: A systematic literature review and meta-analysis. Semin Arthritis Rheum. 2019;49(3):358-65. DOI: https://doi.org/10.1016/j.semarthrit.2019.04.005
Vacchi C, Manfredi A, Cassone G, Cerri S, Della Casa G, Andrisani D, et al. Tofacitinib for the treatment of severe interstitial lung disease related to rheumatoid arthritis. Case Rep Med. 2021;2021:6652845. DOI: https://doi.org/10.1155/2021/6652845
Buschulte K, Hoffmann-Vold A-M, Dobrota RD, Höger P, Krause A, Kreuter M. Treatment of lung fibrosis in systemic rheumatic diseases (new treatment). Z Rheumatol. 2021;80(8):743-54. DOI: https://doi.org/10.1007/s00393-021-01067-3
Lamb YN. Nintedanib: A review in fibrotic interstitial lung diseases. Drugs. 2021;81(5):575-86. DOI: https://doi.org/10.1007/s40265-021-01487-0
Acosta MFC, Garzón NAL, Burbano JAN, Caicedo AIO. Riesgo cardiovascular en artritis reumatoidea: revisión narrativa. Rev. Fac. Cienc. Salud Univ. Cauca. 2017;19(1):27-33.
Ibfelt EH, Jacobsen RK, Kopp TI, Cordtz RL, Jakobsen AS, Seersholm N, et al. Methotrexate and risk of interstitial lung disease and respiratory failure in rheumatoid arthritis: a nationwide population-based study. Rheumatology. 2021;60(1):346-52. DOI: https://doi.org/10.1093/rheumatology/keaa327
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