Multiple peripheral pulmonary nodules preceding rheumatoid arthritis

Area of Science:

• Rheumatology
• Pulmonology
• Pathology

Background:

• Rheumatoid arthritis is a chronic autoimmune disease primarily affecting joints.
• Pulmonary manifestations are known complications of rheumatoid arthritis, but typically occur after joint disease onset.
• Peripheral lung nodules are uncommon presentations of rheumatoid arthritis.

Observation:

• A young woman presented with multiple peripheral lung nodules.
• Computer-assisted tomography indicated nodules of pleural origin with thickened pleura.
• These lung findings preceded the onset of classical rheumatoid arthritis by three months.

Findings:

• Open-lung biopsy revealed rheumatoid necrobiotic nodules.
• The histopathology confirmed the nodules were associated with rheumatoid disease.
• This case highlights an unusual temporal relationship between lung nodules and rheumatoid arthritis.

Implications:

• Rheumatoid arthritis should be considered in the differential diagnosis of unexplained pulmonary nodules.
• Early recognition of pulmonary findings may aid in diagnosing rheumatoid arthritis.
• This case expands the understanding of the spectrum of rheumatoid arthritis presentations.