A CASE SERIES OF PLEURO-PULMONARY MANIFESTATIONS IN RHEUMATOID ARTHRITIS PATIENTS AT A TERTIARY CARE HOSPITAL IN KANCHIPURAM

Abstract

Rheumatoid Arthritis is a systemic inflammatory disorder that most commonly affects the joints, causing progressive, symmetric, erosive destruction of cartilage and bone and is usually associated with autoantibody production. Although joint disease is the main presentation, there are a number of extra-articular manifestations including subcutaneous nodule formation, vasculitis, inflammatory eye disease and lung disease. Of these manifestations, lung disease is a major contributor to morbidity and mortality. There are a variety of pulmonary manifestations of rheumatoid arthritis, including pulmonary parenchymal disease (interstitial lung disease) and inflammation of the pleura (pleural thickening and effusions), airways (bronchiectasis) and pulmonary vasculature (pulmonary hypertension). The present article reports five clinical cases in order to elucidate the diversity of the pathophysiological mechanisms that underlie rheumatoid arthritis associated pulmonary diseases. The five manifestations are: interstitial lung disease, pulmonary hypertension, pleural effusion, bronchiectasis and pulmonary tuberculosis (due to prolonged use of pneumotoxic anti-rheumatoid drugs). This case series illustrates the diagnostic challenges that may occur in pleuro-pulmonary disease associated with RA and also the importance of early diagnosis.