Clinical review for general practice

ISSN (Print) 2713-2552
ISSN (Online) 2782-5671
  • Home
  • about
  • archives
  • contacts
left
FULLSCREEN > Archive > 2023 > Vol 4, №8 (2023) > Rheumatoid nodules in the lungs: difficulties of diagnosis and therapy

Rheumatoid nodules in the lungs: difficulties of diagnosis and therapy

Anastasia V. Sarapulova , Olga V. Teplyakova , Semyon E. Shai

For citation:


  • Abstract
  • About the Author
  • References

Abstract

Rheumatoid arthritis (RA) is the most common systemic connective tissue disease and typically presents pulmonary involvement, which can be of various types. Rheumatoid nodules (RN) of the lungs are one of the most common such lesions and can be potentially dangerous for the development of complications such as pneumothorax. In addition, RN often requires differential diagnosis with other diseases represented by focal formations in the lungs. The article presents two clinical cases related to the development and complication of RN. The first case describes the development of recurrent pneumothorax in a patient with a long history of RA and risk factors for the development of lung disease. The second case is a atypical variant of the onset of RA with simultaneous involvement of the joints and the formation of nodules in the lungs. The results of RN visualization are demonstrated. The presented data are discussed.
Key words: rheumatoid arthritis, rheumatoid nodules, pneumothorax, lung damage.

About the Author

Anastasia V. Sarapulova 1 , Olga V. Teplyakova 1 , Semyon E. Shai 2

1 Ural State Medical University, Ekaterinburg, Russia; Medical Association "New Hospital", Ekaterinburg, Russia

2 Ural State Medical University, Ekaterinburg, Russia

References

1. Esposito AJ, Chu SG, Madan R et al. Thoracic Manifestations of Rheumatoid Arthritis. Clin Chest Med. 2019; 40 (3): 545–60.
2. Dawson JK, Graham DR, Lynch MP. Lung disease in patients with rheumatoid arthritis. CPD Rheumatol. 2002; 3 (2): 38–42.
3. Gauhar UA, Gaffo AL, Alarcón GS. Pulmonary manifestations of rheumatoid arthritis. Semin Respir Crit Care Med. 2007; 28 (4): 430–40.
4. Shaw M, Collins BF, Ho LA, Raghu G. Rheumatoid arthritis-associated lung disease. Eur Respir Rev. 2015; 24 (135): 1–16.
5. Bluett J, Jani M, Symmons DPM. Practical Management of Respiratory Comorbidities in Patients with Rheumatoid Arthritis. Rheumatol Ther. 2017; 4 (2): 309–2.
6. Rosa DJ, Paula EA, Bonfante HLM, et al. Accelerated nodulosis in rheumatoid arthritis during Leflunomide therapy [Article in Portuguese]. Rev Bras Reumatol. 2007; 47 (3): 228–231.
7. van Ede A, den Broeder A, Wagenaar M, et al. Etanercept-related extensive pulmonary nodulosis in a patient with rheumatoid arthritis. J Rheumatol. 2007; 34 (7): 1590–2.
8. Yousem SA, Colby TV, Carrington CB. Lung biopsy in rheumatoid arthritis. Am Rev Respir Dis. 1985; 131 (5): 770–7.
9. Hull S, Mathews JA. Pulmonary necrobiotic nodules as a presenting feature of rheumatoid arthritis. Ann Rheumat Dis. 1982: 41 (1).
10. Akiyama N, Toyoshima M, Kono M et al. Methotrexate-induced accelerated pulmonary nodulosis. Am J Respir Critical Care Med. 2015; 192 (2): 252–3.
11 Yoshikawa GT, Dias GADS, Fujihara S et al. Formation of multiple pulmonary nodules during treatment with leflunomide. Jornal Brasileiro de Pneumologia. 2015; 41 (3): 281–284.
12. Kellet CV, Navarrete RA, Bombardieri SG, Manriquez J. Azathioprine-induced accelerated cutaneous and pulmonary nodulosis in a patient with rheumatoid arthritis. Anais Brasil Dermatol. 2015; 90 (1): 162–4.
13. Rossella Talotta R, Atzeni F, Batticciotto A. Accelerated subcutaneous nodulosis in patients with rheumatoid arthritis treated with tocilizumab: a case series. J Med Case Reports. 2018; (12): 154.
14. Sagdeo P, Gattimallanahali Y, Kakade G, Canchi B. Rheumatoid lung nodule. BMJ Case Reports. 2015; Oct 29: bcr2015213083.
15. Chirila RM, Berianu F, Abril A, Butendieck RR Jr. Extra-articular involvement of rheumatoid arthritis in three seropositive patients in the absence of initial joint involvement. Immun Inflamm Dis. 2021; 9 (4): 1613–7.
16. Karadag F, Polatli M, Senturk T et al. Cavitary necrobiotic nodule imitating malignant lung disease in a patient without articular manifestations of rheumatoid arthritis. J Clin Rheumatol. 2003; 9 (4): 246–52.
17. Aletaha D, Neogi T, Silman AJ et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010; 62 (9): 2569–81.
18. Anderson JK, Zimmerman L, Caplan L, Michaud K. Measures of rheumatoid arthritis disease activity: Patient (PtGA) and Provider (PrGA) Global Assessment of Disease Activity, Disease Activity Score (DAS) and Disease Activity Score with 28-Joint Counts (DAS28), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), Patient Activity Score (PAS) and Patient Activity Score-II (PASII), Routine Assessment of Patient Index Data (RAPID), Rheumatoid Arthritis Disease Activity Index (RADAI) and Rheumatoid Arthritis Disease Activity Index-5 (RADAI-5), Chronic Arthritis Systemic Index (CASI), Patient-Based Disease Activity Score With ESR (PDAS1) and Patient-Based Disease Activity Score without ESR (PDAS2), and Mean Overall Index for Rheumatoid Arthritis (MOI-RA). Arthritis Care Res (Hoboken). 2011; 63 (Suppl. 11): S14–36.
19. Andres M, Vela P, Romera C. Marked improvement of lung rheumatoid nodules after treatment with tocilizumab. Rheumatology. 2012; 51 (6): 1132–4.
20. Kim SH, Yoo WH. Recurrent pneumothorax associated with pulmonary nodules after leflunomide therapy in rheumatoid arthritis: a case report and review of the literature. Rheumatol Int. 2011 Jul; 31 (7): 919–22.
21. Wickrematilake G. Complicated Rheumatoid Nodules in Lung. Case Rep Rheumatol. 2020; 2020: 6627244.
22. Shimomura M, Ishihara S, Iwasaki M. Intractable pneumothorax due to rupture of subpleural rheumatoid nodules: a case report. Surg Case Rep. 2018; 4 (1): 89.
23. Chaudhry AA, Gul M, Chaudhry AA, Moore W. Case 238: Spontaneous Pneumothorax Secondary to Intrapulmonary Necrobiotic Rheumatoid Nodule. Radiology. 2017; 282 (2): 602–8.
23. Ревматоидный артрит. Клинические рекомендации Минздрава России. М., 2021.
Rheumatoid arthritis. Clinical recommendations of the Ministry of Health of Russia. Moscow, 2021 (in Russian).

For citation:Sarapulova A.V., Teplyakova O.V., Shai S.E. Rheumatoid nodules in the lungs: difficulties of diagnosis and therapy. Clinical review for general practice. 2023; 4 (8): 54–59 (In Russ.). DOI: 10.47407/kr2023.4.8.00340


All accepted articles publish licensed under a Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

  • About
  • Editorial board
  • Ethics
  • For authors
  • Author fees
  • Peer review
  • Contacts

oa
crossref
анри


  Indexing

doaj
elibrary

Address of the Editorial Office:

127055, Moscow, s/m 37

Correspondence address:

115054, Moscow, Zhukov passage, 19, fl. 2, room XI


Managing Editor:

+7 (495) 926-29-83

id@con-med.ru