A 58-year-old man with long-standing RA develops progressive shortness of breath. HRCT shows bilateral basal predominant reticulation with honeycombing and traction bronchiectasis. PFTs reveal a restrictive pattern with reduced DLCO. The most likely pulmonary complication of RA is:

• A Organizing pneumonia (OP)
• B Usual interstitial pneumonia (UIP) pattern ILD ✓
• C Pulmonary hypertension
• D Bronchiolitis obliterans

Explanation

The most common ILD pattern in rheumatoid arthritis is UIP, identical radiologically and histologically to idiopathic pulmonary fibrosis, characterized by basal subpleural honeycombing with traction bronchiectasis on HRCT. RA-ILD has a worse prognosis than NSIP (nonspecific interstitial pneumonia), which is more common in polymyositis/dermatomyositis and scleroderma. Organizing pneumonia occurs in RA but is less common than UIP. Bronchiolitis obliterans is rare and associated with penicillamine therapy.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.