Rheumatoid lung changes associated with asbestosis.

The development of a peculiar form of pneumonitis in cases of acute rheumatism was described by Latham in 1845, but a century passed before the publication of the first reports of pulmonary involvement in rheumatoid arthritis. Since the papers of Ellman (1947) and Ellman and Ball (1948) there have been many other reports of lung changes associated with rheumatoid arthritis: in some the nature of the lung disease has been determined at necropsy or by biopsy, but often the lung involvement has only been demonstrated radiologically. In the special field of pneumoconiosis radiological studies led to Caplan's recognition (1953) of a modification in the pattern of anthraco-silicosis when coal-miners developed rheumatoid arthritis. Gough, Rivers, and Seal (1955) showed histologically that the essential difference between the orthodox pneumoconiotic nodules and the Caplan nodules was the presence in the latter of an inflammatory reaction of rheumatoid type. These observations of Caplan and of Gough and his colleagues are not only of interest to workers in dust diseases, but raise issues of immediate importance to the understanding of the basic inflammatory response in rheumatoid arthritis. We have recently had under our care a middleaged man who developed severe rheumatoid disease which was associated with widespread pulmonary fibrosis. Necropsy revealed in the lungs numerous necrobiotic foci of rheumatoid type superimposed upon extensive pulmonary asbestosis. This is the first case of this sort recorded.