Pulmonary Rheumatoid Nodules: Presentation, Methods, Diagnosis and Progression in Reference to 5 Cases

Herrero, Helena Gómez; Sarasa, María A. Martínez; Marco, Inmaculada Rubio; Martín-Moro, Inés García de Eulate

doi:10.1016/j.reumae.2012.06.009

Cited by 9 publications

(6 citation statements)

References 7 publications

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“…29 A study of 5 cases highlights the unpredictable nature of pulmonary rheumatoid nodules, which can evolve, regress, or remain unchanged despite lack of any therapeutic changes. 28 They do not seem to trend with clinical disease course, as has been noted with subcutaneous nodules, and can worsen after initiation of anti-TNF therapy 30 (see section Accelerated Nodulosis).…”

Section: Systemic Location Of Rheumatoid Nodulesmentioning

confidence: 97%

Rheumatoid Nodules

Tilstra

Lienesch

2015

Dermatologic Clinics

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Rheumatoid nodules are a common manifestation of rheumatoid arthritis. These lesions are often easily identified based on typical diagnostic features and characteristic locations. When biopsied, nodules have a characteristic histologic appearance. Uncommonly, rheumatoid nodules can occur in systemic locations. There is no evidence that systemic therapy treats underlying rheumatoid nodules. Paradoxically, methotrexate and possibly tumor necrosis factor inhibitors can increase nodule development. Treatment of rheumatoid nodules is often not necessary, unless patients are experiencing pain or there is interference of mechanical function. This review outlines the available data on and associations of rheumatoid nodules.

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Section: Systemic Location Of Rheumatoid Nodulesmentioning

confidence: 97%

Rheumatoid Nodules

Tilstra

Lienesch

2015

Dermatologic Clinics

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“…Pulmonary nodules constitute the most characteristic and specific lung manifestation of RA, occur rarely, may involve both lungs, and when solitary pose significant differentiation problems from malignancy [62,63] …”

Section: Pulmonary Necrobiotic Nodulesmentioning

confidence: 99%

Investigation of Lung Involvement in Connective Tissue Disorders

Papiris¹,

Manali²,

Kolilekas³

et al. 2015

Respiration

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Lung involvement in connective tissue disorders (CTDs) may present as pleomorphic since any lung compartment may be involved such as airways, exocrine secretory and alveolar epithelia, interstitial lung structure, pulmonary vasculature and pleura as well as, in specific disorders, several tissues of the thoracoabdominal ventilator pump. Any combination of the above anatomic structures may be involved concomitantly although some specific combinations may include a determinant of rheumatic disorders. The diagnosis of a specific CTD requires the fulfilment of clearly defined clinical and laboratory criteria including in most cases positivity for autoantibodies, mostly specific serologic combinations. In this setting, serologic investigation targets mainly, although not exclusively, the detection of antinuclear antibodies. A specific serologic positivity or a combination of autoantibodies constitutes not only a diagnostic criterion for a specific CTD, but may also characterize the pattern of respiratory manifestation in a determinant rheumatic disorder. Therefore, the investigation of lung involvement in CTDs requires adequate skills in the ambit of a multidisciplinary approach and an extended spectrum of diagnostic tools and modalities able to detect both early clinical clues and serologic conversion as well as any pathophysiologic alteration that regards the complexity of respiratory functional status. Although many patients with CTDs suffer from a ‘vicious' combination of lung involvement, lung drug toxicity and infections related to the above two as well as to the ‘mater' disease, for space reasons this review will focus on the established lung manifestations that regard the 7 major CTDs.

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“…Extraarticular manifestations are common in RA and are usually associated with more severe and typically seropositive disease [ 3 ]. Respiratory involvement is a common extra-articular manifestation of RA, with complications involving the pleura, pulmonary vascular system, airway, and lung parenchyma [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Rheumatoid Arthritis With Multiple Lung Nodules: A Case Report

Alhajery

2024

Cureus

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Rheumatoid arthritis (RA) is an inflammatory multisystemic disease characterized by erosive arthritis with many extra-articular manifestations. Pleuropulmonary manifestations are frequently seen in patients with RA. Risk factors include male gender, severe erosive arthritis, high titers of rheumatoid factor, subcutaneous nodules, smoking, genetic predisposition, and the presence of other extra-articular manifestations of RA. We report a patient known to have RA presenting with multiple lung nodules. A 35-year-old female patient, known to have seropositive RA, was diagnosed 10 years ago. She was on oral corticosteroids (OCS) 5 mg daily, Upadacitinib 15 mg daily, and methotrexate (MTX) 20 mg weekly. The patient was referred for pulmonary medicine evaluation because of the finding of multiple lung nodules on chest imaging. A routine chest X-ray conducted as a part of the general evaluation showed a nodular opacity in the right lower lobe. Subsequently, a high-resolution CT (HRCT) scan of the chest was carried out and showed multiple pulmonary nodules. At the time of evaluation, she had no active respiratory symptoms with no signs of respiratory distress. As she was an active smoker, the decision was to proceed with a CT-guided biopsy besides full clinical, hematological, biochemical, and microbiological evaluations. The histopathological findings suggested a rheumatoid nodule with no evidence of malignant or infectious causes. No specific therapy was added at the time being, and the patient was monitored with regular follow-ups. Differentiation of rheumatoid lung nodules from other causes, such as malignancy and infectious causes, is essential. A biopsy with histopathological evaluation is a must in those with a high likelihood of malignancy, such as smokers. In addition to that, comprehensive clinical, hematological, microbiological, and radiological evaluations are required. Rheumatoid lung nodules are usually asymptomatic, with no specific therapy needed apart from the general management of RA with glucocorticoid, immunosuppressive, and biologic therapies.

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Pulmonary Rheumatoid Nodules: Presentation, Methods, Diagnosis and Progression in Reference to 5 Cases

Cited by 9 publications

References 7 publications

Rheumatoid Nodules

Rheumatoid Nodules

Investigation of Lung Involvement in Connective Tissue Disorders

Rheumatoid Arthritis With Multiple Lung Nodules: A Case Report

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