Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a recognized extra-articular manifestation of rheumatoid arthritis. Pulmonary involvement may occasionally precede overt articular disease, creating diagnostic challenges. A patient presented with breathlessness for 2-3 months and joint pain of similar duration, along with bluish discoloration of the left middle finger, suggestive of Raynaud’s phenomenon. Respiratory examination revealed bilateral inspiratory crepitations in the infrascapular and infra-axillary areas. Rheumatoid factor was positive, while antinuclear antibody was negative. High-resolution computed tomography (HRCT) of the thorax demonstrated microcystic honeycombing, basal subpleural fibrosis, and traction bronchiectasis, consistent with a usual interstitial pneumonia (UIP) pattern. This case highlights ILD as a potential early manifestation of rheumatoid arthritis and emphasizes the importance of autoimmune evaluation in patients presenting with fibrotic ILD and systemic features such as Raynaud’s phenomenon.
Ghule et al. (2026) studied this question.