Lung Pathology in Lupus and in Rheumatoid Arthritis

00:01 SLE, well how is this going to then present with lung disease? Acute pneumonitis.

00:06 You're gonna find an acute inflammatory response, however you will not find as many fibroblast.

00:12 Diffuse lung disease here histopathologically referred to as being nonspecific interstitial pneumonitis, which is our topic.

00:20 And the pleural effusion that you'd find here within the lung would be exudative in other words, it would be protein-rich.

00:29 In rheumatoid artritis, what kind of issue might you find in the lung? often presents with progressive fibrosis similar to usual interstitial pneumonitis, and we had talked about that, now do not get confused here.

00:42 If you find abundance of fibrosis dealing with rheumatoid arthritis, that is going to be idiopathic pulmonary fibrosis.

00:48 underlying disorder as far as its response to corticosteroids, minimal at the best.

00:55 However, if you find minimal fibrosis, think of it as being a continuum, then it will be the nonspecific type.

01:02 may also see rheumatoid nodules.

01:04 Now if you find rheumatoid nodules, and you have autoimmune disease, you would then find the symmetric type of lesion in which your patient now has ulnar deviation symmetrically, see this right here This is a cluster type of diagnosis, you see something like this in a patient when he goes out to dinner or whatever then you know that patient is unfortunately, I say that's unfortunate because it's absolutely debilitating.

01:31 and the type of autoantibody that you might find is a rheumatoid factor.

01:36 and the rheumatoid factor is quite dangerous because the more of it that you find, then the prognosis of your patient is that much worse.

01:44 rheumatoid nodules could be a part of a rheumatoid arthritis, same pathology as periepheral nodules.

01:51 also with this type of fibrosis that is occuring, at some point in time, say that it is around the peribronchiolar and if it is around the peribronchioles, with fibrosis what is it going to do? it is then going to obliterate, obliterate the bronchiole Remember please that is a very very nonspecific type of pathogenesis, any condition in which there is increased fibrosis causing damage to the bronchiole resulting in bronchiolitis obliterans Pleural effusion here, also possible.

02:22 What are we looking at for ? Low glucose and the effusion might actually appear as being green Interesting, extremely specific. That should tip you off, that Oh no, my patient with rheumatoid arthritis is having lung issues as well.

02:39 Keep that in mind, very important.

02:40 And also, later on at some point, we'll talk about pneumoconiosis with restrictive lung disease and in that patient with pneumoconiosis and that might have rheumatoid nodules, the combination of the two, you call that Caplan syndrome.

02:58 I'll refer to that again when we get into further detail with pneumoconiosis.

03:02 Not to worry, at this point all we're dealing with is fibrosis or minimal, depending.