Ami Rubinowitz, MD

ABSTRACT: Patients with rheumatoid arthritis (RA) often havepulmonary manifestations, such as interstitial lung disease.The most common cause of upper airway obstruction is cricoarytenoidarthritis. Patients often complain of a pharyngeal foreign-body sensation or hoarseness, but some present with severestridor. Bronchiolitis obliterans is characterized by a rapidonset of dyspnea and dry cough, with inspiratory rales andsqueaks on examination. This presentation, particularly in middle-aged women with seropositive disease, distinguishes bronchiolitisobliterans from other pulmonary manifestations ofRA. High-resolution CT may be more sensitive than pulmonaryfunction tests for detecting small-airways disease, and it frequentlyshows moderate to severe air trapping on expiratoryimages. (J Respir Dis. 2008;29(8):318-324)

ABSTRACT: Pulmonary manifestations, such as pleural effusions,interstitial lung disease (ILD), and rheumatoid nodules, arecommon in patients with rheumatoid arthritis (RA). For thosewith pleural effusions, diagnostic thoracentesis is usually necessaryto rule out other causes. Larger effusions that cause dyspneamay require therapeutic thoracentesis or other interventions.The presentation of ILD is characterized by graduallyprogressive dyspnea on exertion and cough. An isolated decrementin carbon monoxide–diffusing capacity is often the earliestabnormality seen on pulmonary function testing. HighresolutionCT is an important tool for detecting ILD; commonfindings include ground-glass opacities and reticulation. It isimportant to keep in mind that in RA-associated ILD, morethan one pathological process-often several-may be seen inthe same patient. (J Respir Dis. 2008;29(7):274-280)