What are the other Names for this Condition? (Also known as/Symptoms)

• Pulmonary Rheumatoid Nodules
• Rheumatoid Lung Nodules

What is Rheumatoid Nodules of Lung? (Definition/Background Information)

• Rheumatoid lung disease is a collection of various health conditions that occurs due to underlying rheumatoid arthritis (RA). Rheumatoid Nodules of Lung is a rare type of rheumatoid lung disease
• The nodules may be single or multiple and can affect one or both lungs. The condition causes a benign lung mass, which can raise a concern of lung cancer. In many cases, Rheumatoid Nodules of Lung is associated with a background of lung fibrosis. The presence of fibrosis within the lungs can cause adverse health issues
• In a majority of individuals, Rheumatoid Nodules of Lung does not cause significant signs and symptoms due to the presence of the mass in lungs. Nevertheless, the most common signs and symptoms include difficulty in breathing and chest pain. Signs and symptoms can occur due to underlying RA too
• Rheumatoid Nodules of Lung is diagnosed through a physical exam and medical history, blood tests, chest x-rays, pulmonary function tests, and lung biopsies
• The treatment option for Rheumatoid Nodules of Lung include treatment of the underlying rheumatoid arthritis, medications to improve lung function, and removal of fluid from the pleural cavity (if associated fluid in the pleural cavity is found)
• The prognosis of Rheumatoid Nodules of Lung depends upon the severity of the condition and the extent of lung damage

Who gets Rheumatoid Nodules of Lung? (Age and Sex Distribution)

• The presence of Rheumatoid Nodules of Lung in rheumatoid arthritis is uncommon. They occur in less than 1% of the individuals with RA
• Rheumatoid Lung Disease is more commonly seen in men than women. The reason for this is unknown
• This condition is seen worldwide; all racial and ethnic groups are affected

What are the Risk Factors for Rheumatoid Nodules of Lung? (Predisposing Factors)

Apart from rheumatoid arthritis, the following are the risk factors for the development Rheumatoid Nodules of Lung:

• Smoking
• Having a prior lung disease, such as pulmonary fibrosis, asthma, and prior lung infection
• Presence of skin nodules
• Individuals with rheumatoid arthritis having more severe signs and symptoms are more likely to be affected (high levels of rheumatoid factor in blood)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Rheumatoid Nodules of Lung? (Etiology)

• The cause of Rheumatoid Nodules of Lung is unknown in most cases
• Some researchers believe that it is due to an immune dysfunction
• Some medications used to treat rheumatoid arthritis can also result in Rheumatoid Nodules of Lung (medication side effects)

What are the Signs and Symptoms of Rheumatoid Nodules of Lung?

The presence of Rheumatoid Nodules of Lung in itself may not cause any significant signs and symptoms. Nevertheless, the following features may be noted:

• Presence of a well-circumscribed, benign mass in the lung
• The mass/tumor may be solitary or multiple (affecting one lung or both the lungs)
• The tumor can range in size from 0.5-5.0 cm, or it can even be larger
• Shortness of breath
• Fatigue
• The lung mass can cause a concern of lung cancer, and hence, further diagnostic work-up is usually performed to confirm the diagnosis

The associated rheumatoid arthritis and rheumatoid lung disease may present the following features:

• Severe chest pain due to pleural damage
• Persistent cough
• Fibrosis of lungs causing difficulty in breathing
• Signs and symptoms associated with underlying rheumatoid arthritis, such as severe joint pain

Individuals with severe RA develop more severe associated lung disease.

How is Rheumatoid Nodules of Lung Diagnosed?

The diagnosis of Rheumatoid Nodules of Lung may involve the following tests and procedures:

• Complete physical examination with medical history evaluation (including history of rheumatoid arthritis)
• A variety of blood tests to detect the severity of RA can be helpful in assessing the extent of lung damage
• Presence of fibrosis on a chest x-ray or a CT scan of the lungs
• Pulmonary function tests can help determine the extent of lung damage and help the healthcare provider to assess the ability of lungs, to deliver oxygen to the body
• Needle biopsy of lung and/or an open lung biopsy: A tissue biopsy is performed and sent to a laboratory for a pathological examination, who examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

The biopsy may be performed through any of the following procedures:

• Bronchoscopy: A special medical instrument, called a bronchoscope, is inserted through the nose and into the lungs to collect small tissue samples
• Thoracentesis: During thoracentesis, physicians use a special medical device called a cannula, to remove fluid between the lungs and the chest wall for examination
• Thoracoscopy: A medical instrument called a thoracoscope is inserted into the chest through tiny incisions, in order to examine and remove tissue from the chest wall, which is then analyzed further
• Thoracotomy: Thoracotomy is a surgical invasive procedure with special medical instruments to open-up the chest and remove tissue from the chest wall or the surrounding lymph nodes of the lungs
• Mediastinoscopy: A medical instrument called a mediastinoscope is inserted into the chest wall to examine and remove samples
• Fine needle aspiration biopsy (FNAB): A device called a cannula is used to extract tissue or fluid from the lungs, or surrounding lymph nodes

Note: Calcification may be sometimes observed on examination of the nodules.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Rheumatoid Nodules of Lung?

The complications due to Rheumatoid Nodules of Lung include:

• The nodules can rupture into the pleural space causing pneumothorax
• Infection of the pleural cavity (empyema)
• Collection of fluid in the pleural cavity (pleural effusion)

Generally, Rheumatoid Nodules of Lung by itself may not result in any serious complication. However, since it occurs against a background of RA and rheumatoid lung disease, the following complications may be observed:

• Irreversible lung damage such as lung fibrosis
• Development of pneumothorax (collapsed lung)
• Development of pulmonary hypertension, which is indicated by an increased pressure in the arteries of the pulmonary blood vessel system
• Bronchiectasis - due to abnormal scarring of the airways caused by severe inflammation
• Individuals with severe underlying RA have a very high chance of developing lung fibrosis with scarring of lung tissue

How is Rheumatoid Nodules of Lung Treated?

Typically, Rheumatoid Nodules of Lung is an asymptomatic condition having benign lung tumor(s).

• The treatment for the condition is mostly observation - the healthcare provider may choose to follow a ‘wait and watch’ approach
• Some cases are known to get better even without treatment
• If pleural effusion occurs, then pleural tapping procedure may be used to remove the fluid
• In case of infection of the pleural cavity, antibiotics may be prescribed
• Pneumothorax is a medical emergency and has to be treated right away

The treatment of rheumatoid arthritis and associated rheumatoid lung disease must also be undertaken. The treatment measures may include the following:

• Treating underlying rheumatoid arthritis
• Changing medication for underlying RA, which is causing lung damage
• Immunosuppressive therapy using corticosteroids
• In severe cases of rheumatoid lung disease, lung transplantation may be necessary. It is important to note that in individuals with a transplanted lung, the fibrosis can sometimes recur in the transplanted lung

How can Rheumatoid Nodules of Lung be Prevented?

Currently, there are no preventive methods reported for Rheumatoid Nodules of Lung.

• However, treating the underlying rheumatoid arthritis and decreasing its severity can help reduce the chances of developing Pulmonary Rheumatoid Nodules
• Close medical follow-up visits are necessary for individuals with RA, to assess damage to the lungs (if any)

What is the Prognosis of Rheumatoid Nodules of Lung? (Outcome/Resolutions)

Rheumatoid Nodules of Lung is condition that leads to the formation of benign lung masses; it is not related to lung cancer. However, since it occurs in the backdrop of RA and rheumatoid lung disease, the following may be noted:

• The prognosis is based on the severity of lung damage. In majority of cases, there is no severe damage to the lungs
• In some cases, extensive lung fibrosis may require lung transplantation. In such individuals, the prognosis is guarded
• If pulmonary hypertension develops, then the prognosis can be worse, especially if the patient does not respond to treatment

Note: The progression or resolution of Rheumatoid Nodules of Lung is not related to the severity of the underlying rheumatoid arthritis.

Additional and Relevant Useful Information for Rheumatoid Nodules of Lung:

• Rheumatoid arthritis (RA) is a chronic auto-immune systemic inflammatory disorder that may affect the lining of joints, surrounding tissues, or organs within the body

The following link will help you understand rheumatoid arthritis better:

http://www.dovemed.com/diseases-conditions/rheumatoid-arthritis-ra/