A 45-year-old woman with RA on methotrexate develops progressive dyspnoea and a honeycombing pattern on HRCT. Pulmonary function shows restrictive pattern with reduced DLCO. Her RA is well controlled. What is the most likely pulmonary complication?
- A RA-associated usual interstitial pneumonia (UIP-RA) ✓
- B Methotrexate-induced hypersensitivity pneumonitis
- C Organising pneumonia
- D Pleural effusion with atelectasis
Correct answer: A. RA-associated usual interstitial pneumonia (UIP-RA)
Explanation
RA-associated ILD most commonly presents as UIP pattern (similar to IPF) with basal-predominant honeycombing on HRCT. It is the most common cause of RA-related pulmonary fibrosis and carries a prognosis similar to IPF. Methotrexate pneumonitis typically presents acutely/subacutely with bilateral ground-glass opacities and fever — not a honeycombing pattern. Organising pneumonia in RA shows consolidation rather than honeycombing. UIP-RA has prognostic significance distinct from other RA-ILD patterns (NSIP, OP).
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.