SHM Converge Scientific Abstract ePoster Gallery-Challenges in Managing Rheumatoid Arthritis-Associated Interstitial Lung Disease Exacerbation

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This case describes a patient with rheumatoid arthritis–associated interstitial lung disease (RA-ILD) who developed a severe acute respiratory illness requiring escalating oxygen and immunosuppressive support over a 15-day hospital course.<br /><br />During days 1–3, the patient was treated with 3–6 L nasal cannula, antibiotics, and low-dose steroids. By days 4–6, respiratory status worsened, requiring high-flow nasal cannula (HFNC) and BiPAP, along with higher-dose steroids, broadened antibiotics, and daily diuretics. On day 7, an echocardiogram showed reduced left ventricular ejection fraction (LVEF) of 35–40%, and guideline-directed medical therapy (GDMT) was started. Days 8–9 were marked by weaning off BiPAP but continued need for HFNC at 8–9 L/min. On days 10–12, the patient received pulse-dose methylprednisolone 1000 mg daily. By days 13–15, the patient improved to 2 L nasal cannula, repeat echocardiogram showed recovery of LVEF to 55%, and GDMT was stopped.<br /><br />The discussion notes that radiologic findings in RA-ILD are often nonspecific and may include bibasilar ground-glass opacities, honeycombing, and reticular or nodular changes, similar to this patient’s CT findings. The exact mechanism of acute exacerbation remains uncertain, with possibilities including an overactive autoimmune response, a separate inflammatory process, or both. High-dose steroids may help blunt either immune-mediated lung injury or inflammation related to infection.<br /><br />Because the patient was a lifelong nonsmoker without other major risk factors, RA-ILD was considered the most likely cause of the presentation. The transient heart failure with reduced ejection fraction may have been related to both rheumatoid arthritis and stress response, since RA is associated with a higher incidence of left-sided heart failure.

Asset Subtitle

Irina Balan

Meta Tag

Author List Amandeep Gujral, Irina Balan, John Pidakala

Category Clinical Vignettes

Concept Rheumatoid Arthritis-Associated Interstitial Lung Disease

Concept Ground-Glass Opacities

Concept Honeycombing

Concept Exacerbation

Concept Corticosteroid

Distinguished Non-Finalist

Presenter Organization Campbell University Harnett Health Family Medicine

Presenting Author Irina Balan

Track Adult

Keywords

rheumatoid arthritis

interstitial lung disease

RA-ILD

acute respiratory illness

high-flow nasal cannula

BiPAP

pulse-dose methylprednisolone

ground-glass opacities

heart failure with reduced ejection fraction

guideline-directed medical therapy

Rheumatoid Arthritis-Associated Interstitial Lung Disease

Ground-Glass Opacities

Honeycombing

Exacerbation

Corticosteroid