Can latent TB scaring be misdiagnosed as interstitial lung disease with RA?

Hello,

Welcome to icliniq.com. I can understand your concern. According to your statement, you have been suffering from chronic bronchitis with rheumatoid arthritis with recently diagnosed with RA related interstitial lung disease or idiopathic pulmonary fibrosis. You had a history of pulmonary tuberculosis (PTB) and taking anti-tubercular drugs. You are concerned about your recent diagnosis based on high resolution computed tomography (HRCT) chest whether it is rheumatoid arthritis associated interstitial lung disease (RA-ILD)/idiopathic pulmonary fibrosis (IPF) or latent tuberculosis (TB) related complications for your past sufferings and now you feel a lot better. Your HRCT of chest reveals (attachment removed to protect patient identity), interstitial fibrosis characterized by peripheral traction bronchiectasis, irregular reticulation in all lobes, microtubules with calcification in mid and lower lungs, lower lobe predominant microcystic changes without significant ground glass opacifications, hilar calcified lymph nodes consistent with chronic granulomatous disease, and bronchial wall thickening bilaterally. Similar type of radiological findings can be found in post TB fibrosis, chronic obstructive pulmonary disease which includes two key components chronic bronchitis and emphysema, RA-ILD or IPF, etc. You may not tell your doctor about your previous history of Latent TB. For that reason his diagnosis was RA-ILD or IPF as you are suffering from RA. So he was not wrong as your radiological reports suggest the above mentioned differential diagnosis. Again, on high altitude, your doctor found crackles as you are suffering from chronic obstructive pulmonary disease (COPD) and it may be associated with infections that time and now it not heard as your infection was subsided.

Hello,

Welcome back to iclniq.com. According to your query, people who develop rheumatoid arthritis associated interstitial lung disease (RA related ILD) have a median survival rate of 3.2 years to 8.1 years from the time of diagnosis as some research shows. Further lung complications can develop and become increasingly severe. According to arthritis society 10% of people who have RA can be affected by ILD or idiopathic pulmonary fibrosis (IPF) as a complication of RA. But you can reduce your risk by not smoking and by getting regular checkups to monitor breathing and check for lung problems. When a doctor can diagnose rheumatoid lung disease early it may be easier to treat and thus help to increase median survival rate like you. Your rheumatologist gave you some medications like a steroid to reduce its progress. Due to ILD or IPF, if scar tissue has built up in your lungs it will stay but the medications will slow down the process. Do not worry about it. It is possible to catch TB more than once, if you are unlucky enough to breathe in TB bacteria at another time. Always take new TB symptoms seriously and get them checked out by a doctor as CDC tells even TB germs in your body are dormant and they are very strong. Many germs are killed after taking antitubercular drugs but some stay alive in your body for a long time. If those people suffer from any autoimmune disorder like RA can wake up the dormant TB germ when body immunity systems are declined. ILD or IPF can be a long term complication of pulmonary tuberculosis (PTB). You are using medications like Infliximab and it can cause ILD and TB too.