A 62-year-old man, with a 12-year history of seropositive RA, was presented with shortness of breath, myalgia and weight loss. Earlier, he had habit of smoking 40 cigarettes a day. Physical Examination He was found pale and thin, with generalized muscle tenderness. Small bilateral pleural effusions were present with widespread crepitations over both lung fields.
His joints were tender and he had subluxation of the metacarpophalangeal joints of both hands rather than another typical feature - Swan-neck deformalities. There was bilateral cervical and axillary lymph node enlargement but no splenomegaly. Neurological and cardiac examinations were normal. Biochemical investigations Raised CRP - (81mg/l) Normochromic anaemia - (Hb 94g/l) Serum IgG - 42g/l (Normal Range 7.2-19.0) IgA and IgM levels - Normal Rheumatoid factor titre - 1/1280 (Normal Range <1/32) No detectable antibodies to DNA…
