Severe lung injury in a patient with chronic rheumatoid arthritis: a case report

Lung injury is a common extra-articular manifestation of rheumatoid arthritis (RA). Lung involvement is usually characterized by insidious onset, but has poor prognosis with significant worsening in patients' quality of life, disability and often fatal outcome. Lung injury could be caused both by the rheumatoid disease, drug toxicity and opportunistic infection related to immunosuppression. Active screening using high-resolution computed tomography (HRCT) of the lungs revealed frequent subclinical pulmonary abnormalities, but their prognostic role remains unclear. Moreover, HRCT does not allow differentiating between RA-associated lung injury and drug toxicity. Currently, overestimation of drug-induced lung injury and underestimation of rheumatoid disease as a cause of lung damage are often seen in clinical practice. A case report presented in this article demonstrates pulmonary involvement in rheumatoid disease.

1. Olson A.L., Swigris J.J., Sprunger D.B. et al. Rheumatoid arthritis-interstitial lung disease-associated mortality. Am. J. Respir. Crit. Care Med. 2011; 183 (3): 372–378. DOI: 10.1164/rccm.201004-0622OC.

2. Paulin F., Doyle T.J., Fletcher E.A. et al. Rheumatoid arthritis-associated interstitial lung disease and idiopathic pulmonary fibrosis: shared mechanistic and phenotypic traits suggest overlapping disease mechanisms. Rev. Invest. Clin. 2015; 67 (5): 280–286.

3. Necterovich I.I., Nochevnaya K.V., Rabik Yu.D. et al. Comprehensive clinical and laboratory diagnosis of lung injury in patients with rheumatoid arthritis. Nauchno-prakticheskaya revmatologiya. 2016; 5 (54): 535–542. DOI: 10.14412/1995-4484-2016-535-542 (in Russian).

4. Tsuchiya Y., Takayanagi N., Sugiura H. et al. Lung diseases directly associated with rheumatoid arthritis and their relationship to outcome. Eur. Respir. J. 2011; 37 (6): 1411–1417. DOI: 10.1183/09031936.00019210.

5. Gochuico B.R., Avila N.A., Chow C.K. et al. Progressive preclinical interstitial lung disease in rheumatoid arthritis. Arch. Intern. Med. 2008; 168 (2): 159–166. DOI: 10.1001/archinternmed.2007.59.

6. Averkieva Yu.V., Raskina T.A., Malyshenko O.S. et al. Interstitial lung disease in patients with rheumatoid arthritis. Sovremennaya revmatologiya. 2014; 8 (1): 27–30 (in Russian).

7. Demoruelle M.K., Weisman M.H., Simonian P.L. et al. Brief report: Airways abnormalities and rheumatoid arthritis-related autoantibodies in subjects without arthritis: early injury or initiating site of autoimmunity? Arthritis Rheum. 2012; 64 (6): 1756–1761. DOI: 10.1002/art.34344.

8. Murav'ev Yu.V. Lung disease in patients with rheumatoid arthritis caused by basic anti-inflammatory therapy. Nauchno-prakticheskaya revmatologiya. 2010; 48 (6): 80–85 (in Russian).

9. Manjunatha Y., Seith A., Kandpal H., Das C. Rheumatoid аrthritis: spectrum of computed tomographic findings in pulmonary diseases. Curr. Probl. Diagn. Radiol. 2010; 39 (6): 235–246. DOI: 10.1067/j.cpradiol.2009.06.002.

10. Бестаев Д.В., Божьева Л.А., Волков А.В. и др. Субклиническая форма интерстициального поражения легких при ревматоидном артрите. Клиницист. 2015; 1: 30–36. DOI: 10.17650/1818-8338-2015-1-30-36.

11. Conway R., Carey J.J. Methotrexate and lung disease in rheumatoid arthritis. Panminerva Med. 2017; 59 (1): 33–46. DOI: 10.23736/S0031-0808.16.03260-2.

12. Mori S., Koga Y., Sugimoto M. Small airway obstruction in patients with rheumatoid arthritis. Mod. Rheumatol. 2011; 21 (2): 164–173. DOI: 10.3109/s10165-010-0376-5.