Diagnostic and Management Challenges of Rheumatoid Arthritis-Associated Interstitial Lung Disease in a Ugandan...

Rheumatoid arthritis (RA)-associated interstitial lung disease (ILD) is a serious complication of RA, characterized by progressive pulmonary fibrosis. Diagnosing and managing RA-ILD can be particularly challenging in resource-limited settings, where access to advanced diagnostic tools and treatment options may be limited. Early detection and intervention are critical for improving outcomes.

A 40-year-old female with a six-year history of RA (rheumatoid factor positive) presented with a three-month history of worsening cough, shortness of breath, and chest pain. On examination, she exhibited signs of respiratory distress and digital clubbing. Baseline oxygen saturation was 81% on 5 L/min supplemental oxygen. Chest X-ray revealed bilateral reticular opacities, while a CT scan showed bilateral fibrotic changes and ground-glass opacities, suggestive of an NSIP-like pattern, although formal HRCT classification could not be confirmed. Anti-CCP testing and pulmonary function tests were unavailable due to resource limitations. The patient was managed with supplemental oxygen therapy, corticosteroids, and methotrexate, along with lifestyle modifications and pulmonary rehabilitation. Follow-up over two months showed marked symptomatic improvement.

This case emphasizes the challenges of diagnosing and managing RA-associated ILD in resource-limited settings. It highlights the importance of clinical suspicion, pragmatic use of available resources, and the need to strengthen diagnostic capacity in low-resource environments.