Correct!
5. Usual interstitial pneumonitis –UIP
Rheumatoid arthritis (RA) is one of the most common autoimmune conditions worldwide. CT abnormalities of the lungs can occur in 50-70% of patients. The disease can affect the lung parenchyma, airways, or pleura. Occasionally, airway involvement of RA may be the first manifestation of systemic RA. Clinically significant ILD related to RA (RA-ILD) can happen in up to 10% of RA patients. The most common ILD pattern found in patients with RA-ILD is UIP – usual interstitial pneumonitis - characterized by basal predominate architectural distortion with reticulation, traction bronchiectasis, and honeycombing. Other pulmonary manifestations that can be seen in RA include airways disease which can be characterized by bronchiectasis, constrictive bronchiolitis, as well as follicular bronchiolitis. Occasionally, necrobiotic nodules can be found that can mimic lung cancer with pathology on biopsy showing fibrinoid necrosis and granulomatous inflammation which can regress with therapy.
Our patient has a history of RA-ILD in a UIP pattern as well as paraseptal emphysema from a history of smoking who was followed closely in pulmonary clinic (Figure 2) now presenting with a new, subacute illness.
Figure 2. Left: Representative images from the CT scan of the patient’s chest approximately 6 months prior to admission while being followed in Pulmonary Clinic for asymptomatic basilar-predominate fibrosis secondary to RA-ILD and paraseptal emphysema. Right: video of CT scan. To view Figure 2 in a separate, enlarged window click here. To view a video of the CT scan click here.
Which of the following diagnostic tests should be completed on admission? (Click on the correct answer to be directed to the third of seven pages)
