title: Pulmonary vasculitis as the first manifestation of rheumatoid arthritis.
abstract: In this report, we describe a 61-year-old man that presented with isolated pulmonary vasculitis and a positive anti-cyclic citrullinated peptide (CCP) antibody. Within a few months, the patient developed the symmetric polyarthritis consistent with rheumatoid arthritis (RA). Because the anti-CCP antibody is highly specific for RA and vasculitis is a known association of RA, we suspect the pulmonary vasculitis in this patient was the first manifestation of underlying RA. This case extends on previous reports that have shown that lung disease may predate the development of articular RA and that anti-CCP positivity and lung disease may represent a pre-RA phenotype. To our knowledge, this is the first case report of pulmonary vasculitis as the first manifestation of RA.
authors.affiliation: Peak Pulmonary Consulting Inc., Calgary, Alberta, Canada.
authors.forename: Olga
authors.initials: O
authors.lastname: Tourin
authors.affiliation: Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: de la Torre Carazo
authors.affiliation: National Jewish Health, Denver, CO 80206, USA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Smith
authors.affiliation: National Jewish Health, Denver, CO 80206, USA.
authors.forename: Aryeh
authors.initials: A
authors.lastname: Fischer
keywords: Lungs; Pulmonary; Rheumatoid arthritis; Vasculitis