RA c/b ILD (COP biopsy 2003) on tofacitinib and low dose prednisone who has been followed in the ILD clinic.

 

He has established RA (seropositive) and ILD. He has long standing lung disease (see below) but was reasonably stable until 2018 when started feeling unwell with troublesome cough and dyspnea on exertion. He also noted intermittent night sweats.

He has had lung disease starting around 2003 when he presented with BOOP (biopsy in 2003, see below), responsive to prednisone. He was later diagnosed with RA

1 year ago

cough at night occasionally productive of clear sputum for the preceding 2 months but declined any fevers, worsening dyspnea, or night sweats.  At the time given the radiographic and physiologic progression of the underlying ILD he was started on nintedanib, TTE was requested, and we discussed the possibility of referral to a lung transplant center.

Normal biventricular  size and  systolic function  with LVEF 65%. No regional wall  motion abnormalities.  Normal biatrial  size. Mild aortic and mitral  leaflet thickening  without stenosis.  Mild MR.
Otherwise valves  appear functionally  normal. Trace  TR with estimated PA systolic  pressure of  32 mmHg, assuming  RA pressure of 3 mmHg. Interatrial  septum appears  intact by color  Doppler. IVC is normal size. No significant  pericardial  effusion. Compared  to prior
report of 4/2005,  similar findings.

 

Pulmonary Function Trend Report

 

Date	FVC	FEV1	ratio	FeF25-75	TLC	RV	DLCO
8/24/20	3.4 98%	2.75 101%	81	2.7 103%	5.47 95%	1.93 93%	8.17 35%
5/16/19	3.18 84%	2.64 89%	79	3.29 115%	—	—	8.1 35%

 

ILD conference – concensus was that the current radiographic pattern is consistent with RA-ILD in an UIP pattern

 

8 years ago – Hx of RA

15 years ago

1 year ago

 

References

Arakawa et al AJR 2011