A 67-year-old man has a long history of symmetrical small joint arthritis with deformities. He now develops shortness of breath on exertion with a dry cough, but no sputum or chest discomfort. His heart sounds have a loud P2, and the lungs have fine bibasilar crackles. Which of the following is the most likely diagnosis of the pulmonary condition associated with his arthritis?
Correct Answer: interstitial fibrosis
Description: In RA, pleural involvement is very common at autopsy but infrequently causes symptoms. Interstitial lung disease (ILD) is the most common manifestation of rheumatoid lung disease. RA associated interstitial lung disease (RA-ILD) is usually similar to idiopathic pulmonary fibrosis (IPF) in terms of its clinical presentation, pathology, disease spectrum, and pathogenesis. Presentation is more common at age 50-60 years, in men (M:F=2-3:1), and in association with seropositive and erosive joint disease. If pleural fluid is present, glucose levels are very low.
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