Download

Download Full Text (162 KB)

Description

Rheumatoid arthritis (RA) is a systemic inflammatory disease that typically involves joint space destruction. Patients with rheumatoid arthritis can also experience pleural disease, one type being pneumothorax [1]. Pneumothorax is defined as the accumulation of air in the pleural space with collapse of the lung. This can occur in Rheumatoid Arthritis due to the rupture of a rheumatoid nodule or bleb, causing a bronchopleural fistula [2] [3]. We present a case of a patient who had weaned off her steroids for her rheumatoid arthritis that subsequently presented with pneumothorax.

A 65-year-old female with a history of recurrent pneumothorax requiring right chemical and mechanical pleurodesis in 2022 and RA on chronic steroids since 2019 (recently tapered off due to side effects of bone loss) and adalimumab. She presented to the emergency department with dyspnea after having a positive influenza test and a chest X-ray revealing right pneumothorax as an outpatient. On admission, she was febrile, tachypneic, hypertensive, and oxygenating at 99% on 2L nasal cannula. Laboratory results showed leukopenia, elevated rheumatoid factor (RF), and positive cyclic citrullinated peptide (CCP) antibody. Repeat chest X-ray showed moderate right pneumothorax in the right lung base, similar to the study completed as an outpatient the day before.

Rheumatoid arthritis has been linked to recurrent pneumothorax in the setting of rheumatoid nodules and bronchopulmonary fistula; however, no cases have been reported of recurrent pneumothorax after weaning off steroids. The patient reported that she had weaned off her steroids due to side effects. With her RA symptoms and inflammatory markers worsening after her taper, it is plausible that this taper may have led to her pneumothorax.    In summary, weaning off chronic steroids in RA could lead to worsening of the disease and complications including pneumothorax.

Publication Date

5-8-2026

Disciplines

Internal Medicine

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2023

RA, You Take My Breath Away: Recurrent Pneumothorax in a Patient with Rheumatoid Arthritis Who was Weaned off Chronic Steroids

Share

COinS