Correct!
5. All of the above

The pulmonary function testing shows a restrictive defect and likely explains the patient’s dyspnea. The rheumatology consult was skeptical of the diagnosis of rheumatoid arthritis. Rheumatoid factors are antibodies (usually IgM) directed against IgG. Contrary to what the name suggests, rheumatoid factors are found not only in rheumatoid arthritis (RA) but in up to 4% of healthy individuals and a wide range of other autoimmune and some non-autoimmune diseases (1). In rheumatoid arthritis the anti-CCP is usually positive and can help distinguish rheumatoid arthritis from other disorders (2).
The patient had a previous VATS lung biopsy which was reviewed (Figure 3).

Figure 2. Low-power (A) and high-power (B,C) hematoxylin & eosin-stained pathology slides from a surgical lung biopsy (left lower lobe) demonstrating scattered lymphoid aggregates and follicles (A, B) with patchy granulomatous organizing pneumonia (C) consistent with a nonspecific interstitial pneumonitis (NSIP) pattern. To view Figure 2 in a separate, enlarged window click here.

Which of the following are correct? (Click on the corrrect answer to be directed to the fifth of six pages)

1. The lung histology suggests systemic connective tissue disease-related interstitial lung disease.
2. The lung histology is diagnostic of rheumatoid arthritis associated lung disease.
3. The clinical situation and the lung histology are consistent with psoriatic interstitial lung disease.
4. 1 and 3
5. All of the above

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