Necrobiotic nodules with silicosis
Pathologically, only difference is ring
of dust in nodule which produces
darkened ring around central core
Roentgenographically identical to
rheumatoid nodules in RA
Rheumatoid Lung
Caplan’s Syndrome
Rheumatoid Disease with Pulmonary
Arterial Hypertension
Due to an arteritis which produces PAH
and eventual cor pulmonale
Rheumatoid Lung
Pulmonary Hypertension
Same as BOOP except patients have RA
Rheumatoid Lung
BOOP
The End
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Slides
1. Rheumatoid Lung
2. Rheumatoid Lung
3. Rheumatoid Lung General
4. Rheumatoid Lung Cause
5. Rheumatoid Lung Manifestations
6. Rheumatoid Lung Pleural Effusion
7. Pleural Effusion Characteristics
8. Pleural Effusion Characteristics
9. Pleural Effusion Characteristics
10.
11. Rheumatoid Lung Pulmonary Fibrosis
12.
13. Rheumatoid Lung Necrobiotic Nodules
14.
15. Rheumatoid Lung Caplan’s Syndrome
16. Rheumatoid Lung Pulmonary Hypertension
17. Rheumatoid Lung BOOP
18.
Rheumatoid Lung
©
Copyright
William Herring, MD, FACR
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Rheumatoid Lung
Extra-articular manifestations more
common in males
Disease more common in females
Clinically
Shortness of breath most common
Subcutaneous rheumatoid nodules often
present
PFTs show restrictive disease
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Rheumatoid Lung
General
Most patients with pulmonary evidence
of RA have
Clinical evidence of the disease
Severe arthritic disease
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Circulating antibody
Largely IgM in patients with RA
Changes in lung probably immune in
origin
Rheumatoid Lung
Cause
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Pleural effusion
Pulmonary fibrosis
Necrobiotic nodules
Caplan’s Syndrome
Pulmonary Arterial Hypertension
Obliterative Bronchiolitis
Rheumatoid Lung
Manifestations
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Most common manifestation of
RA in chest
Rheumatoid Lung
Pleural Effusion
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Pleural Effusion
Characteristics
Exudate
Very low sugar content (< 30 mg/100 ml)
Does not rise with IV administration of
glucose
Low sugar effusion in TB rises with IV
glucose
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Pleural fluid in RA
High in LDH
Rich in lymphocytes
Positive for Rheumatoid Factor
Contains low complement levels
Pleural Effusion
Characteristics
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Effusion may remain unchanged for
months or years
Most are unilateral
Can occur on either side
Effusion almost never associated with
parenchymal disease
Pleural Effusion
Characteristics
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Pleural Effusions in RA
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Begins micronodular
coarse reticulation
More prominent at bases
Indistinguishable from scleroderma
Honeycomb appearance
Rheumatoid Lung
Pulmonary Fibrosis
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Bibasilar Interstitial Disease in RA
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Relatively rare
Usually occur with subcutaneous nodules
Identical pathologically to them
Usually well circumscribed masses
Typically multiple
Subpleural in location with cavitation
Frequently at bases
Rheumatoid Lung
Necrobiotic Nodules
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Necrobiotic Nodule in RA
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