Rheumatoid Arthritis

Question 1

How can rheumatoid arthritis affect the lungs?

Answer 1

It affects the lungs, skin and heart

The drugs used to treat it can also affect the lungs

Question 2

What is methotrexate?

Answer 2

An immunosuppressant associated with interstitial lung disease

Question 3

What are the signs that indicate interstitial lung disease?

Answer 3

1. treatment with methotrexate and steroids
2. progressive breathlessness
3. persistent non-productive cough
4. fine inspiratory crackles

Question 4

What is the most common lung disease that occurs as a result of rheumatoid arthritis?

Answer 4

Interstitial fibrosis/pneumonitis

Question 5

What is interstitial lung disease associated with and what is the median age of people it affects?

Answer 5

associated with seropositive and erosive joint disease

median age is 50 - 60 years

Question 6

What is rheumatoid arthritis and what does it cause?

Answer 6

It is a chronic, systemic inflammatory disorder

It is symmetrical and may be remitting

It causes joint destruction due to erosion of cartilage and bone

Question 7

Why is interstitial lung disease hard to diagnose?

Answer 7

It can present with acute or progressive symptoms

It is difficult to diagnose due to various presentations

Question 8

Is interstitial lung disease an obstructive or restrictive lung disease?

Answer 8

restrictive

Question 9

How does the FEV1/FVC ratio change in interstitial lung disease?

Answer 9

FVC is reduced as the lung becomes stiff

FEV1 is reduced or normal as there is no change in the airways

FEV1/FVC ratio is unchanged or increased

Question 10

What other signs are usually present to help diagnosis?

Answer 10

Finger clubbing

Crackles on inspiration

Question 11

What structures are affected in rheumatoid arthritis?

Answer 11

All of them - the capsules, cartilages and bones

there are often rheumatoid nodules on the joints

Question 12

What do nodular changes look like in the lungs on a chest X-ray?

Answer 12

“Honeycombing pattern”

it appears like a net on the base of the lung

Question 13

How does methotrexate affect the lung?

Answer 13

Methotrexate lung can cause hypersensitivity pneumonitis

Stopping the drug slows down the progression but doesn’t reverse the effects

Question 14

What are the main side effects of steroid therapy?

Answer 14

1. thrush
2. bruising
3. increased weight
4. Cushingoid
5. Increased risk of infection
6. osteoporosis