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Rheumatoid Lung Disease

  • RA-associated interstitial lung disease (RA-ILD).
  • Pleural disease (pleural thickening/effusions).
  • Airway disease (Both upper & lower airway).
  • Rheumatoid nodules
  • Drug-induced lung toxicity (i.e., Methotrexate-induced lung injury)
  • Fibro-bullous disease
  • Thoracic cage immobility
  • Venous thromboembolic disease
  • Vasculitis
  • Pneumonia.
RHEUMATOID EFFUSION:
  • WCC <5000/mm3
  • Fluid glucose <60 mg/Dl
  • Pleural fluid to serum glucose ratio < 0.5
  • pH < 7.3
  • High pleural LDH level (ie, > 700 IU/L)
  • Cytology: Slender or elongated multinucleated macrophages, round giant multinucleated macrophages, and necrotic background debris.
Pulmonary function testing in ILD (PFT):
  • Reduced VC, lung volumes, & DLCO.
  • Oxygen desaturation during exercise.
  • Restrictive abnormalities common (poor muscle strength or kyphosis due to osteoporosis rather than ILD).


 

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