Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea and a persistent non-productive cough. Known history of seropositive Rheumatoid Arthritis (RA) currently managed with [Medication]. Symptoms are chronic and slowly progressive, associated with fatigue and occasional pleuritic chest pain. No history of occupational dust exposure, smoking, or recent respiratory infections.
Clinical Examination Findings
Vitals: Stable, SpO2 [Value]% on room air. Chest: Bilateral fine end-inspiratory crackles (Velcro-like) heard predominantly at the lung bases. Cardiovascular: Regular rate and rhythm, no signs of right heart failure (no JVD or peripheral edema). Musculoskeletal: Deformities of small joints of hands/feet consistent with RA, no active synovitis noted.
Treatment Protocol
Plan: 1. Initiate/Adjust immunosuppressive therapy (e.g., Mycophenolate Mofetil or Rituximab) to address both RA and ILD progression. 2. Pulmonary rehabilitation referral. 3. Supplemental oxygen if SpO2 <88% at rest or exertion. 4. Monitor PFTs (FVC and DLCO) every 3-6 months. 5. Smoking cessation counseling.