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How do you approach management of a patient with multiple lung nodules and low titer +CCP but no active joint symptoms suggestive of RA?
Negative RF. No evidence of inflammatory arthropathy on hand MRI. ANCA negative.
Lung nodule bx: benign fibrovascular tissue with areas of small granulomas and multinucleated giant cells. AFB negative. No evidence of malignancy.
Answer from: at Academic Institution
In the absence of other clinical symptomatology, I would favor close observation and follow-up in this case as there is no established diagnosis and repeat CT, PFT’s in 3 to 6 months. Details of initial evaluation should include PET-CT to exclude malignancy but also to investigate other organ ...
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Answer from: at Community Practice
Agree with this approach. High CCP may not sway me either, but if it were an ILD case, I would then approach her as an IPAF (interstitial Pneumonitis with Autoimmune Features).