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Pulmonary Fibrosis

Prognosis with pulmonary fibrosis

04/24/2009

Question:

I was diagnosid 12 months ago with pulmonary fibrosis after suffering from shortness of breath for approx 1 year. I have rheumatoid arthritis and lupus and was on methrexate. Tests showed that I have lost one third of the use of my lungs, but at the moment I do not seem to be getting any worse. Can you give me a prognosis.

Answer:

There are several causes of interstitial lung disease in the setting of rheumatoid arthritis. Rheumatoid arthritis-associated UIP (usual interstitial pneumonitis) is perhaps the most serious and can ultimately be fatal; however, it tends to progress slower than UIP associated with idiopathic pulmonary fibrosis (idiopathic pulmonary fibrosis is a lung disease that occurs by itself without other underlying conditions such as rheumatoid arthritis). 

Rheumatoid arthritis-associated NSIP (non-specific interstitial pneumonitis) has a better prognosis than UIP and can often be controlled with medications such as prednisone, CellCept, Imuran, or Cytoxan. Drug-induced interstitial lung disease can also occur from the medications used to treat rheumatoid arthritis; for example, methotrexate is an important cause of interstitial lung disease. Drug-induced lung disease can often stabilize once the offending drug is stopped. 

Lastly, infection can mimic interstitial lung disease, and patients taking medications to treat rheumatoid arthritis that affect the immune system can be more prone to developing low grade infections. The first step is to determine which of these causes of interstitial lung disease is responsible for your condition. Once the specific type of interstitial lung disease is determined, the prognosis can be better predicted. Often seeing a pulmonologist can help in sorting this out.

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Response by:

James N Allen, Jr, MD James N Allen, Jr, MD
Clinical Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University