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NSIP Pattern — RACP Adult Medicine MCQ

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HardRespiratoryNSIP PatternRACP Adult Medicine

A 55-year-old woman with RA on methotrexate presents with progressive dyspnoea. HRCT shows bilateral basal ground-glass opacities with subpleural sparing and lower lobe predominance. There is no honeycombing. Lung biopsy shows uniform interstitial inflammation and fibrosis. What is the most likely ILD pattern?

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Correct answer: A — NSIP

Bilateral basal GGO with subpleural sparing (characteristic feature) and uniform inflammation/fibrosis on biopsy is NSIP pattern. NSIP is the most common ILD pattern in CTD-associated ILD (RA, SSc, dermatomyositis). It has a better prognosis than UIP/IPF. Cellular NSIP responds to immunosuppression (corticosteroids + mycophenolate/azathioprine). Fibrotic NSIP has intermediate prognosis. Subpleural sparing on HRCT helps distinguish from UIP (which shows subpleural honeycombing).

Reference: ATS/ERS – 2013 – IIP Classification; eTG Respiratory 2024