Clinical case of a patient with rheumatoid arthritis and pulmonary rheumatoid nodules treated with Tocilizumab

Abstract

Rheumatoid arthritis is the most common disorder  of the spectrum of inflammatory arthropaties  worldwide. It is a chronic autoimmune disease with clinical manifestation of  symmetrical erosive polyarthritis of small and large joints in the upper and lower extremities. In some forms of the disease, involvement of other organs and systems is observed. The case report we present is of a young polymorbid patient who we diagnosed with seropositive rheumatoid arthritis. In the course of treatment with Methotrexate,  a rare manifestation of the disease with lung  involvement was found , where multiple rheumatoid nodules were seen using several imaging methods. A biopsy of a nodule was done and histologically verified. Although rheumatoid nodules are the most common extra-articular manifestation of the disease (25%), pulmonary localization is very rare, varying between 1-5% according to different sources. The patient’s comorbidities significantly limit the possibilities of treatment and makes it a therapeutic problem.  Biologic therapy with an anti-IL-6 monoclonal antibody was initiated. On follow-up radiography 5 months later, the rheumatoid nodules had regressed.