Eraut D, Evans J, Caplin M
Br J Dis Chest. 1978 Oct;72(4):301-6.
Pulmonary necrobiotic nodules are the least common of the pulmonary lesions associated with rheumatoid arthritis. Histologically they are identical to subcutaneous rheumatoid nodules. Systemic rheumatoid arthritis usually precedes the development of pulmonary nodules. Seven cases where the pulmonary nodule appeared before or without the development of systemic rheumatoid arthritis are described. The typical histological and radiological features of necrobiotic nodules were found in each. In five of the seven the nodules were in more than one site and in five there were cavitating nodules. Spontaneous improvement occurred in one case. Pulmonary nodules preceded systemic rheumatoid arthritis in three cases and in the remaining four cases systemic rheumatoid arthritis has not yet appeared despite prolonged follow-up. In all patients, tests for rheumatoid factor have remained negative. The absence of circulating rheumatoid factor and systemic rheumatoid arthritis cannot exclude the diagnosis in these cases if the histological diagnosis is accepted as conclusive.
肺部坏死性结节是类风湿关节炎相关肺部病变中最不常见的。从组织学上看，它们与皮下类风湿结节相同。系统性类风湿关节炎通常先于肺部结节出现。本文描述了7例肺部结节在系统性类风湿关节炎出现之前或未出现系统性类风湿关节炎时就已出现的病例。每例均发现了坏死性结节典型的组织学和放射学特征。7例中有5例结节位于多个部位，5例有结节空洞形成。1例出现自发改善。3例肺部结节先于系统性类风湿关节炎出现，其余4例尽管经过长时间随访，系统性类风湿关节炎仍未出现。所有患者类风湿因子检测均为阴性。如果组织学诊断被认为是决定性的，在这些病例中，循环类风湿因子的缺乏和系统性类风湿关节炎的未出现并不能排除诊断。
