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RA and lung issues, ground glass opacity

I am a long term RA patient who is now seeing a pulmonologist for shortness of breath. All cardiac tests were normal. Several ground glass opacities in my right lung showed up on a CT scan in July 2011. Enbrel was discontinued and coincidentally I took a regime of prednisone for an allergy problem - 60 mg for one week, then with a weekly taper. A repeat CT scan was performed in December 2011 and one ground glass opacity remained (15 mm), with a small focus of sold component within the ground glass density. A percutaneous biopsy was performed to rule out bronchogenic carcinoma. After the biopsy, the radiologist informed me that he thought they missed the lesion. The tissue was determined to be non-malignant and inflammatory tissue. The biopsy was not cultured even though my rheumatologist was concerned about infection or inflammation. The current idea is to wait and follow up with another CT in 2 months. My rheumatologist wants me to stay off Enbrel and methotrexate, so I am miserable. I was off Enbrel for 4 years as it caused a dangerous drop in my blood counts, but went back on it a little over a year ago.

My shortness of breath was improved while on the prednisone, but I am a long time prednisone user so my drs do not want me to be on it any longer. Now the shortness of breath is causing me discomfort again. My chest feels heavy and the lymph nodes under my armpit are very tender and lumpy.  

My drs don't talk to each other frequently and I often feel left out of the loop. I am going to start working with a case manager to try to improve this.

Any help anyone can give me would be greatly appreciated.
5 Responses
Avatar universal
I forgot to include that the first CT showed numerous enlarged axillary lymph nodes that the drs performed core biopsies on - no evidence of malignancies, only 'reactive' tissue.  These lymph nodes have resolved!
Avatar universal
Funny - Med Help just sent me an email to pick the best answer to my question when no one answered it at all!  
771990 tn?1341779376
I too have RA. Ive only had it since 2010 but it was severe at the beginning! Flipped my world upside down. I was tried on Humira and Enbrel. They discontinued the Humira because it was not helping. They discontinued the Enbrel because of side effects. Now I am on Plaquenil. I also get Rituxan infusions.I am on 15 mg of Prednisone but being tapered because I have been on it since 2009 and they want me off it because of the problems it is causing me.I have been diagnosed with Interstitial Lung Disease and Pulmonary Fibrosis. Also Traction Bronchiectasis. I am on 5 ltrs of oxygen 24/7 for the Fibrosis.

These are my last two CT Scans:

CT Scan: 11/18/10- Lungs: Bilateral upper and lower lobe interstitial thickening with groundglass opacities and traction bronchiectasis. Splenic granuloma. Spenule is present. Hepatic Steatosis (fatty liver).

CT Scan: 1/20/12- There is cylindrical bronchiectasis in the lower lobes with greater changes on the left than the right. There is some septal thickening in the Periphery of areas of both upper lobes and involving both lower lobes with greater changes on the left. No significant adenopathy is seen.

I also have an enlarged heart.

You mentioned getting a case manager so they could all be on the same page. I have run into that trouble as well. How do you go about getting a case manager for your health issues?

I am not sure how else I can help you with what you need to know. But you are not alone.
Avatar universal
Thanks for the reply. It is helpful to know that I am not alone, as much of the time I feel so alone in all of this.  I am getting a case manager from my insurance - it is their way of saving money but staying on top on tests, treatment, etc., but it can be helpful to me.  My biggest issue is that my drs do not really answer all my questions and then I am left wondering.

I too have been on prednisone and am trying to stay off of it, but many times it is the only med I can tolerate.

Good luck with your treatment and thanks for the reply!
Avatar universal
MEDICAL PROFESSIONAL
Hello and hope you are doing well.

Post infection, there could be some amount of bronchospasm and this could be causing the problems with breathing. This can be detected by a spirometry test. Have yourself evaluated for the same. Bronchodilators will help clear the bronchospasm. In the meantime try to take warm oral fluids and do steam inhalations prior to your meals. This helps to loosen up and bring out the secretions.  

Hope this helped and do keep us posted.
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