Case Report

A simultaneous onset of organizing pneumonia and rheumatoid arthritis, along with a review of the literature

Authors

Shunsuke Mori¹, Isamu Cho², Yukinori Koga³ and Mineharu Sugimoto⁴

1. Clinical Research Center for Rheumatic Disease and Department of Rheumatology, Kumamoto Saishunsou National Hospital, 2659 Suya, Kohshi, Kumamoto 861-1196, Japan
2. Clinical Research Center for Rheumatic Disease and Division of Respiratory Medicine, Department of Medicine, Kumamoto Saishunsou National Hospital, Kumamoto, Japan
3. Clinical Research Center for Rheumatic Disease and Department of Radiology, Kumamoto Saishunsou National Hospital, Kumamoto, Japan
4. Division of Respiratory Medicine, Department of Medicine, Kumamoto Saishunsou National Hospital, Kumamoto, Japan

Received:

20 July 2007

Accepted:

15 August 2007

Published online:

26 December 2007

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Abstract

Organizing pneumonia (OP) is a specific type of interstitial pneumonia that has been noted as one of the pulmonary manifestations during the course of rheumatoid arthritis (RA). In this study, we report a case with a simultaneous development of OP and RA. The patient presented with concurrent flu-like symptoms and arthralgia of multiple joints, and antibiotic therapy was not effective. The rheumatoid factor (RF) and anti-cyclic citrullinated antibodies were both high. Multiple air-space opacities on chest radiographs and bilateral peripheral consolidations on high-resolution computed tomography films were evident. The histology of transbronchial lung biopsy samples was characterized by intra-alveolar buds of granulation tissue consisting of intermixed myofibroblasts and connective tissues. Treatment with prednisolone induced a complete recovery from OP without relapses. Our review of previous reports about RA-associated OP (RA-OP) suggested that the high titer of RF and increased disease activity of RA indicate a great risk of developing OP. This condition may represent a lung’s reaction in the RA-associated inflammatory and/or immune process. We should be aware of RA-OP cases in which pulmonary manifestations precede articular symptoms. In these cases, respiratory manifestations are the main evidence of RA activity. In most cases of steroid-resistant RA-OP, the use of immunosuppressants was effective. Since OP may progress to fibrotic lung disease during the course of RA, we may consider performing a second lung biopsy for steroid-resistant patients, even if they have once been diagnosed as OP.

Key words

Bronchiolitis obliterans with organizing pneumonia - Interstitial pneumonia - Organizing pneumonia - Rheumatoid arthritis - Rheumatoid factor