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Rheumatoid arthritis-associated interstitial lung disease — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Rheumatoid arthritis-associated interstitial lung diseaseUSMLE Step 3

A 57-year-old woman with rheumatoid arthritis has 3 months of progressive exertional dyspnea and dry cough. She takes methotrexate and adalimumab. Oxygen saturation is 92% on room air. Chest CT shows basilar reticulation and traction bronchiectasis. Pulmonary function tests show reduced FVC and reduced DLCO. Which of the following is the most likely diagnosis?

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Correct answer: B — Interstitial lung disease associated with rheumatoid arthritis

RA can cause interstitial lung disease, typically with exertional dyspnea, dry cough, restrictive PFTs, impaired DLCO, and fibrotic CT changes. The chronic course and imaging are not consistent with asthma or acute PE.

Reference: American Thoracic Society interstitial lung disease principles