Nambu Y, Iwata T, Oida K, Kohri Y, Taguchi Y, Tomii K, Mino M, Yunoki Y, Ichijima K, Kobashi Y
Department of Respiratory Medicine, Tenri Hospital, Nara Pref., Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1991 Jun;29(6):734-9.
A 54-year-old woman under treatment for rheumatoid arthritis was admitted because of aggravation of dyspnea on effort and restrictive pulmonary dysfunction. Although chest X-ray revealed no marked change, the symptoms progressively worsened, necessitating open lung biopsy for diagnosis and treatment. Based on the histopathological findings of the biopsied tissue, the patient was diagnosed as having active rheumatoid lung complicated with cellular interstitial pneumonia and follicular bronchiolitis. The patient responded well to adrenocorticosteroid and immunosuppressor therapy, and is now being followed up as an outpatient. Rheumatoid arthritis can be complicated by diverse lung diseases. Among them one important disease is interstitial pneumonia, which serves as a prognostic factor. When cellular interstitial pneumonia is treated with adrenocorticosteroid therapy, it responds well and its prognosis is good. Therefore, its early detection and appropriate adrenocortical therapy are essential. Patients with rheumatoid arthritis presenting with dyspnea on effort and pulmonary dysfunction should be examined for cellular interstitial pneumonia, follicular bronchiolitis and other lung diseases, even when no marked change is visible on chest X-ray films.
一名正在接受类风湿关节炎治疗的54岁女性因劳力性呼吸困难加重和限制性肺功能障碍入院。尽管胸部X线检查未发现明显变化，但症状逐渐恶化，因此需要进行开胸肺活检以明确诊断和治疗。根据活检组织的组织病理学检查结果，该患者被诊断为活动性类风湿肺合并细胞性间质性肺炎和滤泡性细支气管炎。患者对肾上腺皮质激素和免疫抑制剂治疗反应良好，目前作为门诊患者进行随访。类风湿关节炎可并发多种肺部疾病。其中一种重要的疾病是间质性肺炎，它是一个预后因素。当细胞性间质性肺炎采用肾上腺皮质激素治疗时，反应良好且预后较好。因此，早期发现和适当的肾上腺皮质治疗至关重要。即使胸部X线片上没有明显变化，出现劳力性呼吸困难和肺功能障碍的类风湿关节炎患者也应检查是否存在细胞性间质性肺炎、滤泡性细支气管炎和其他肺部疾病。
