Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea, non-productive cough, and constitutional symptoms including low-grade fever and fatigue. History notable for "mechanic’s hands," inflammatory arthritis, and Raynaud’s phenomenon. No reported dysphagia or proximal muscle weakness. Symptoms consistent with Antisynthetase Syndrome-associated interstitial lung disease (AS-ILD).
Clinical Examination Findings
General appearance: Alert and oriented. Respiratory: Bilateral fine end-inspiratory bibasilar crackles (Velcro-like). Musculoskeletal: Hyperkeratosis and fissuring of the palmar surfaces (mechanic’s hands), mild joint tenderness in MCP/PIP joints. Integumentary: No active rashes or Gottron’s papules noted. Cardiovascular: Regular rate and rhythm, no signs of right heart failure (no JVD or peripheral edema).
Treatment Protocol
Initiate immunosuppressive therapy with high-dose corticosteroids (prednisone taper). Consider steroid-sparing agents such as Mycophenolate Mofetil or Azathioprine for long-term management. Monitor pulmonary function tests (PFTs) and DLCO every 3 months. Physical therapy referral for muscle strength maintenance and pulmonary rehabilitation.