Acute lung changes in rheumatoid arthritis.

Much has been written about the'controversial subject of respiratory system involvement in rheumatoid arthritis since the paper of Eliman and Ball (1948). It is now generally accepted that certain respiratory conditions, although more or less uncommon, are true manifestations of rheumatoid disease. These are rheumatoid nodules occurring in pleura and lungs (Robertson and Brinkman, 1961) and nodular fibrosis associated with co-existing pneumoconiosis (Caplan 1953, 1959); also pleurisy and pleural effusions (Horler and Thomson, 1959; Ward, 1961) and diffuse interstitial pulmonary fibrosis (Lee and Brain, 1962; Brannan, Good, Divertie, and Baggenstoss, 1964) may occur in rheumatoid disease without any other aetiology. Although mention is made in the last two papers of acute pneumonia-like illnesses at the onset or during exacerbations of the chronic pulmonary disease, little attention has been paid to acute lung changes in rheumatoid arthritis. In patients with rheumatoid arthritis there are obvious difficulties in excluding associated or purely coincidental causes of acute pulmonary lesions and in attributing such changes to the rheumatoid process itself. We report here three cases of rheumatoid arthritis with acute lung lesions believed to be manifestations of rheumatoid disease as they occurred in association with the recognized rheumatoid phenomena of pleurisy and pericarditis (Tarpley, 1961; Wilkinson, 1962). The diagnostic criteria for rheumatoid arthritis are those of the American Rheumatism Association (Ropes, Bennett, Cobb, Jacox, and Jessar, 1959).