Skip to main content

Advertisement

SpringerLink
Log in

A simultaneous onset of organizing pneumonia and rheumatoid arthritis, along with a review of the literature

  • Case Report
  • Published:
Modern Rheumatology

Abstract

Organizing pneumonia (OP) is a specific type of interstitial pneumonia that has been noted as one of the pulmonary manifestations during the course of rheumatoid arthritis (RA). In this study, we report a case with a simultaneous development of OP and RA. The patient presented with concurrent flu-like symptoms and arthralgia of multiple joints, and antibiotic therapy was not effective. The rheumatoid factor (RF) and anti-cyclic citrullinated antibodies were both high. Multiple air-space opacities on chest radiographs and bilateral peripheral consolidations on high-resolution computed tomography films were evident. The histology of transbronchial lung biopsy samples was characterized by intra-alveolar buds of granulation tissue consisting of intermixed myofibroblasts and connective tissues. Treatment with prednisolone induced a complete recovery from OP without relapses. Our review of previous reports about RA-associated OP (RA-OP) suggested that the high titer of RF and increased disease activity of RA indicate a great risk of developing OP. This condition may represent a lung’s reaction in the RA-associated inflammatory and/or immune process. We should be aware of RA-OP cases in which pulmonary manifestations precede articular symptoms. In these cases, respiratory manifestations are the main evidence of RA activity. In most cases of steroid-resistant RA-OP, the use of immunosuppressants was effective. Since OP may progress to fibrotic lung disease during the course of RA, we may consider performing a second lung biopsy for steroid-resistant patients, even if they have once been diagnosed as OP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Davison AG, Heard BE, McAllister WA, Turner-Warwick ME. Cryptogenic organizing pneumonitis. Q J Med. 1983;52:382–94.

    PubMed  CAS  Google Scholar 

  2. Epler GR, Colby TV, McLoud TC et al. Bronchiolitis obliterans organizing pneumonia. N Engl J Med. 1985;312:152–8.

    Article  PubMed  CAS  Google Scholar 

  3. Polverosi R, Maffesanti M, Dalpiaz G. Organizing pneumonia: typical and atypical HRCT patterns. Radiol Med (Torino). 2006;111:202–12.

    Article  CAS  Google Scholar 

  4. Cordier JF. Cryptogenic organising pneumonia. Eur Respir J. 2006;28:422–46.

    Article  PubMed  Google Scholar 

  5. Hansell DM. What are bronchiolitis obliterans organizing pneumonia (BOOP) and cryptogenic organizing pneumonia (COP)? Clin Radiol. 1992;45:369–70.

    Article  PubMed  CAS  Google Scholar 

  6. Colby TV. Pathologic aspects of bronchiolitis obliterans organizing pneumonia. Chest. 1992;102:38S–43S.

    Article  PubMed  CAS  Google Scholar 

  7. Myers JL, Colby TV. Pathologic manifestations of bronchiolitis, constrictive bronchiolitis, cryptogenic organizing pneumonia, and diffuse panbronchiolitis. Clin Chest Med. 1993;14:611–22.

    PubMed  CAS  Google Scholar 

  8. Rees JH, Woodhead MA, Sheppard MN, du Bois RM. Rheumatoid arthritis and cryptogenic organising pneumonitis. Respir Med. 1991;85:243–6.

    Article  PubMed  CAS  Google Scholar 

  9. Kitaichi M. Differential diagnosis of bronchiolitis obliterans organizing pneumonia. Chest. 1992;102:44S–49S.

    Article  PubMed  CAS  Google Scholar 

  10. King TE Jr, Mortenson RL. Cryptogenic organizing pneumonitis. The North American experience. Chest. 1992;102:8S–13S.

    Article  PubMed  Google Scholar 

  11. Ippolito JA, Palmer L, Spector S et al. Bronchiolitis obliterans organizing pneumonia and rheumatoid arthritis. Semin Arthritis Rheum. 1993;23:70–8.

    Article  PubMed  CAS  Google Scholar 

  12. van Thiel RJ, van der Burg S, Groote AD et al. Bronchiolitis obliterans organizing pneumonia and rheumatoid arthritis. Eur Respir J. 1991;4:905–11.

    PubMed  Google Scholar 

  13. Flowers JR, Clunie G, Burke M, Constant O. Bronchiolitis obliterans organizing pneumonia: the clinical and radiological features of seven cases and a review of the literature. Clin Radiol. 1992;45:371–7.

    Article  PubMed  CAS  Google Scholar 

  14. Anaya JM, Diethelm L, Ortiz LA et al. Pulmonary involvement in rheumatoid arthritis. Semin Arthritis Rheum. 1995;24:242–54.

    Article  PubMed  CAS  Google Scholar 

  15. Yousem SA, Colby TV, Carrington CB. Lung biopsy in rheumatoid arthritis. Am Rev Respir Dis. 1985;131:770–7.

    PubMed  CAS  Google Scholar 

  16. Iwaki M, Kato K, Suganuma S, Ogawa M. A case of subacute progressive BOOP related with rheumatoid arthritis. J Chubu Rheum Assoc. 2005;36:72–3.

    Google Scholar 

  17. Egawa S, Ako H, Hamada K et al. A case of bronchiolitis obliterans organizing pneumonia associated with rheumatoid arthritis. Nihon Kyobu Rinsyo. 1992;51:59–64.

    Google Scholar 

  18. Araki N, Matsumoto K, Taki F et al. A case of interstitial pneumonia antedating rheumatoid arthritis–differentiation from idiopathic BOOP. Nihon Kyobu Shikkan Gakkai Zasshi. 1994;32:249–54.

    PubMed  CAS  Google Scholar 

  19. Pommepuy I, Farny M, Billey T et al. Bronchiolitis obliterans organizing pneumonia in a patient with rheumatoid arthritis. Rev Rhum Engl Ed. 1998;65:65–7.

    PubMed  CAS  Google Scholar 

  20. Taniguchi H, Fujinaga H, Abo H et al. Successful treatment with low-dose cyclosporin in a case of organizing pneumonia with rheumatoid arthritis. Nihon Kyoubu Rinsyo. 2006;65:846–51.

    Google Scholar 

  21. Nakamura K, Hirakata M, Fujii T et al. Three cases with systemic rheumatic diseases who developed pulmonary lesions suggestive of bronchiolitis obliterans organizing pneumonia. Ryumachi. 1995;35:9–14.

    PubMed  CAS  Google Scholar 

  22. Kakazu T, Kaneshima H, Tamaki K et al. A case of bronchiolitis obliterans organizing pneumonia in a patient with rheumatoid arthritis. Nihon Kyobu Shikkan Gakkai Zasshi. 1990;28:493–8.

    PubMed  CAS  Google Scholar 

  23. Katikireddy CK, Krishna G, Berry G et al. A 24-year-old woman with bilateral pulmonary infiltrates, pericardial effusion, and bilateral pleural effusions. Chest. 2005;128:4013–7.

    Article  PubMed  Google Scholar 

  24. Miyagawa Y, Nagata N, Nakanishi Y et al. A case of steroid-responsive organizing pneumonia in a patient with rheumatoid arthritis showing migratory infiltration and normal glucose levels in pleural effusions. Br J Rheumatol. 1993;32:829–31.

    Article  PubMed  CAS  Google Scholar 

  25. Taniguchi H, Nakajima Y, Ogawa K et al. A case of bronchiolitis obliterans organizing pneumonia in a patient with rheumatoid arthritis. Nihon Kyobu Shikkan Gakkai Zasshi. 1987;25:1027–31.

    PubMed  CAS  Google Scholar 

  26. Yoshida K, Nakajima M, Niki Y, Matsushima T. Atelectasis of the right lower lobe in association with bronchiolitis obliterans organizing pneumonia. Nihon Kokyuki Gakkai Zasshi. 2001;39:260–5.

    PubMed  CAS  Google Scholar 

  27. Harada M, Hashimoto O, Kumemura H et al. Bronchiolitis obliterans organizing pneumonia in a patient with primary biliary cirrhosis and rheumatoid arthritis treated with prednisolone. Hepatol Res. 2002;23:301.

    Article  PubMed  Google Scholar 

  28. Ueki K, Nishida H, Marutsuka K, Sumiyoshi A. A case of BOOP associated with rheumatoid arthritis. Nihon Kyoubu Rinsyo. 1993;52:443–8.

    Google Scholar 

  29. Kondoh Y, Taki F, Ando M et al. A case of bronchiolitis oblitrans organizing pneumonia in a patient with rheumatoid arthritis who responded to corticosteroid and immunosupressant therapy. Nihon Kyobu Shikkan Gakkai Zasshi. 1992;30:1165–70.

    PubMed  CAS  Google Scholar 

  30. Itoh H, Kitagawa T, Kitaoka K et al. A case of rheumatoid arthritis associated with pernicious anemia and bronchiolitis obliterans organizing pneumonia. Ryumachi. 1995;35:920–6.

    PubMed  CAS  Google Scholar 

  31. Yamamoto M, Ina Y, Kitaichi M et al. Clinical features of BOOP in Japan. Chest. 1992;102:21S–25S.

    Article  PubMed  CAS  Google Scholar 

  32. Vittecoq O, Pouplin S, Krzanowska K et al. Rheumatoid factor is the strongest predictor of radiological progression of rheumatoid arthritis in a three-year prospective study in community-recruited patients. Rheumatology (Oxford). 2003;42:939–46.

    Article  CAS  Google Scholar 

  33. Epler GR. Bronchiolitis obliterans organizing pneumonia. Semin Respir Infect. 1995;10:65–77.

    PubMed  CAS  Google Scholar 

  34. Cohen AJ, King TE Jr, Downey GP. Rapidly progressive bronchiolitis obliterans with organizing pneumonia. Am J Respir Crit Care Med. 1994;149:1670–5.

    PubMed  CAS  Google Scholar 

  35. Schlesinger C, Koss MN. The organizing pneumonias: an update and review. Curr Opin Pulm Med. 2005;11:422–30.

    Article  PubMed  Google Scholar 

  36. Kajiya T, Kuroda A, Hokonohara D, Tei C. Radiographic appearance of bronchiolitis obliterans organizing pneumonia (BOOP) developing during Bucillamine treatment for rheumatoid arthritis. Am J Med Sci. 2006;332:39–42.

    Article  PubMed  Google Scholar 

  37. Lee YH, Kim YR, Ji JD et al. A case of BOOP developed during bucillamine treatment for rheumatoid. Korean J Intern Med. 2001;16:36–9.

    PubMed  CAS  Google Scholar 

  38. Ulubas B, Sahin G, Ozer C et al. Bronchiolitis obliterans organizing pneumonia associated with sulfasalazine in a patient with rheumatoid arthritis. Clin Rheumatol. 2004;23:249–51.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work has received no financial support that may pose conflicts of interest.

Author information

Authors and Affiliations

  1. Clinical Research Center for Rheumatic Disease and Department of Rheumatology, Kumamoto Saishunsou National Hospital, 2659 Suya, Kohshi, Kumamoto, 861-1196, Japan

    Shunsuke Mori

  2. Clinical Research Center for Rheumatic Disease and Division of Respiratory Medicine, Department of Medicine, Kumamoto Saishunsou National Hospital, Kumamoto, Japan

    Isamu Cho

  3. Clinical Research Center for Rheumatic Disease and Department of Radiology, Kumamoto Saishunsou National Hospital, Kumamoto, Japan

    Yukinori Koga

  4. Division of Respiratory Medicine, Department of Medicine, Kumamoto Saishunsou National Hospital, Kumamoto, Japan

    Mineharu Sugimoto

Authors
  1. Shunsuke Mori
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Isamu Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yukinori Koga
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mineharu Sugimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shunsuke Mori.

About this article

Cite this article

Mori, S., Cho, I., Koga, Y. et al. A simultaneous onset of organizing pneumonia and rheumatoid arthritis, along with a review of the literature. Mod Rheumatol 18, 60–66 (2008). https://doi.org/10.1007/s10165-007-0004-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10165-007-0004-1

Keywords

Search

Navigation