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Can rheumatoid arthritis cause pulmonary fibrosis?

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Posted on Mon, 7 Dec 2015
Question: For non specific intetitistial pneumonia , are traces of fibrosis found on lungs in a rheumatoid arthritis patient?
doctor
Answered by Dr. Panagiotis Zografakis (10 hours later)
Hello,

rheumatoid arthritis may cause fibrosis to the lung, nodules or pleural effusion. A CT scan can be used to identify these lesions. Clinical examination can provide clues to the lesions as well. Not every patient will have such lesions though.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (2 hours later)
Thanks. . We have been told fibrosis to lungs thatd all we know so far . Is this serious?
doctor
Answered by Dr. Panagiotis Zografakis (36 minutes later)
Brief Answer:
it depends

Detailed Answer:
You're welcome!

How serious it is, depends on the extent of damage already done and the progressiveness of the disease. Idiopathic pulmonary fibrosis, which is a grave condition, has a mortality rate of 50% over a 5 year period. Many fibrotic changes (non-idiopathic) progress less aggressively though. So the prognosis depends on the progressiveness of the disease in any particular patient.

There are treatments for it which include corticosteroids and immunosuppressive treatment (methotrexate/azathrioprine/cyclophosphamide). But the answer to your question is yes... it's serious and may cause severe morbidity unless successfully treated.

I hope you find my comments helpful!
You can contact me again, if you'd like any clarification or further information.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (2 hours later)
I see .but with rhuematoid arthritis which type of fibrosis is likely? Is it usual intestial pneumonia?
doctor
Answered by Dr. Panagiotis Zografakis (19 minutes later)
Brief Answer:
there is more than one type...

Detailed Answer:
Rheumatoid arthritis may cause histopathologic variations which may have different prognosis. Non-specific interstitial pneumonia (NSIP), usual interstitial pneumonia (UIP), lymphocytic interstitial pneumonia (LIP), cryptogenic organizing pneumonia (COP) and diffuse alveolar damage (DAD). The most common patterns for rheumatoid arthritis are NSIP and UIP and they affect almost 10% of patients.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (15 minutes later)
Ok
Is prognosis
Poor for both?
doctor
Answered by Dr. Panagiotis Zografakis (15 minutes later)
Brief Answer:
the prognosis is not good

Detailed Answer:
The prognosis is not good. After being diagnosed with a rheumatoid arthritis related interstitial lung disease the median survival is 2 and a half years for UIP (half of patients will be alive by then). Take into account though that this is statistics and what applies for a patient may not apply for the other. For NSIP the median survival is much longer, approaching 12-14 years after diagnosis. Also please consider the fact that some patients may present with a relatively stable disease. So it all depends on the aggressiveness of the underlying process.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (12 minutes later)
I see . So
Which one u think is more common UIP or NIP? But my mum
In law has no
Symptoms . Only severe joint pains .

Can the medications halt the disease at all ?
doctor
Answered by Dr. Panagiotis Zografakis (14 minutes later)
Brief Answer:
UIP is more common

Detailed Answer:
UIP accounts for almost half of cases of rheumatoid arthritis related cases. NSIP accounts for one third of cases.
It's great that she has no symptoms! Having symptoms signifies disease progression obviously. The medications may help but not always. When fibrosis predominates (which will cause symptoms) the outcomes are worse.

Kind Regards!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (3 minutes later)
So if no symptoms at the present time, is prognosis better then or is it still not so good ?

With NIP can u see fibrosis too ?

There were traces of fibrosis on a chest xray
doctor
Answered by Dr. Panagiotis Zografakis (13 minutes later)
Brief Answer:
NSIP can present with fibrosis

Detailed Answer:
UIP has a rapid progression, which means that symptoms appear early in its course. NSIP may present with fibrosis too and this is the most common presentation. If the pulmonologist is in doubt, a biopsy might help. Differentiating UIP from other types of interstitial disease is important because all the other types benefit more from treatment.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (14 minutes later)
She has had arthritis many years untreated and over the past year been getting worse.

So UIP or NIP are the likely 2 right? The fact that there are no chest symptoms, does that suggest NIP?
doctor
Answered by Dr. Panagiotis Zografakis (18 minutes later)
Brief Answer:
not necessarily

Detailed Answer:
The two most common types are indeed UIP and NSIP. Clinical data are not sufficient to distinguish between them. Although UIP causes a rapidly progressive disease and NSIP may not, this is not enough to say which one it is in her case. The pulmonologist will evaluate the films and the clinical status and may decide for a biopsy. Sometimes the biopsy is not required but it's the most definite way to establish the diagnosis.

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (12 minutes later)
Ok this is not likely to be the others then like COP, DAD, LIP?

Also is fibrosis known as scarring?
doctor
Answered by Dr. Panagiotis Zografakis (3 minutes later)
Brief Answer:
I can't say but the statistics suggest so

Detailed Answer:
Nobody can say which type of fibrosis it is, without a biopsy. Based on statistics you can "predict" various things in medicine but as I've pointed out emphatically enough (hopefully!) you can never be absolutely certain.

Fibrosis and scarring mean the same thing. Fibrosis is a more scientific term for scarring.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (1 hour later)
Thanks . Even though no symptoms
Present now, can they still arise ?

Also, can the drugs halt progression or not always?
doctor
Answered by Dr. Panagiotis Zografakis (53 minutes later)
Brief Answer:
symptoms may develop

Detailed Answer:
You're welcome!

Symptoms may develop even if she has none right now but keep in mind that minimal fibrosis could be unrelated to rheumatoid arthritis (although I doubt it). The drugs may sometimes halt the progression to more severe disease. The disease may even regress. If it's IUP though, the hopes are not too high...

Kind Regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Panagiotis Zografakis

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Practicing since :1999

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Can rheumatoid arthritis cause pulmonary fibrosis?

Hello, rheumatoid arthritis may cause fibrosis to the lung, nodules or pleural effusion. A CT scan can be used to identify these lesions. Clinical examination can provide clues to the lesions as well. Not every patient will have such lesions though. Kind Regards!