How do you approach dyspnea in a patient with seropositive rheumatoid arthritis with normal imaging findings but abnormal PFT findings (restriction, reduced DLCO)?  

Pulmonary pathophysiological abnormalities are common in individuals with rheumatoid arthritis (RA) and respiratory symptoms. In individuals without respiratory symptoms, abnormalities may even be detected by lung function testing or high-resolution CT imaging. Any compartment of the lungs may be in...

I first do a careful history and physical. Does the patient have significant arthropathy or features of other CTDs? Sometimes, RA (and scleroderma) can reduce lung volumes due to the effects of arthropathy or tissue stiffening, respectively. Any drugs such as DMARDs that could induce a pneumonitis (...

Assuming you mean normal high-resolution chest CT, I would look for the other causes of those physiologic abnormalities. Muscle weakness, potentially from an overlap autoimmune disease, could lead to the restriction. Reductions in DLCO should lead us to look at the pulmonary vascular. All symptoms o...