J Rheum Dis.  2011 Mar;18(1):36-40. 10.4078/jrd.2011.18.1.36.

A Case of Caplan's Syndrome Presenting as Acute Onset Polyarthritis

• Ryu HH
• Chang SH
• Kim HW
• Shin K
• Lee EB
• Yim JJ
• Song YW

• KMID: 2223180
• DOI: http://doi.org/10.4078/jrd.2011.18.1.36

Abstract

Caplan originally described distinctive pulmonary nodules in miners who had suffered from rheumatoid arthritis. Later, the pulmonary nodules, together with a history of rheumatoid arthritis and exposure to inorganic dust were called Caplan's syndrome. This syndrome has been described by case reports in many countries but only two cases have been reported in Korea up to now. The patient in this case report was a 70-years-old man who had worked in the construction field for 20 years mainly demolishing buildings. He was diagnosed with silicosis by a lung biopsy 1 year prior to admission. He suddenly developed arthralgia and morning stiffness in multiple joints 2 weeks prior to admission. Chest imaging revealed aggravation of the bilateral pulmonary nodules. He was diagnosed with seropositive rheumatoid arthritis. The lung nodules, arthralgia, and morning stiffness improved clinically after treatment with the corticosteroid and disease modifying anti-rheumatic drugs.

Keyword

Caplan's syndrome; Rheumatoid arthritis; Pneumoconiosis; Silicosis

MeSH Terms

Antirheumatic Agents
Arthralgia
Arthritis
Arthritis, Rheumatoid
Biopsy
Caplan Syndrome
Dust
Humans
Joints
Korea
Lung
Pneumoconiosis
Silicosis
Thorax
Antirheumatic Agents
Dust

Figure

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  Figure 1. Increased size of multiple nodular opacities in both lungs (A: 1 year prior to admission, B: recent admission).

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  Figure 2. Aggravated multi-nodular opacities with right pleural effusion (A) and decreased extent of both lung lesions after steroid treatment for 6 weeks (B).

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  Figure 3. Serial changes in ESR and disease activity score (DAS)28-ESR. (A) started prednisolone (Pd), (B) added methot-rexate (MTX), hydroxychloroquine (HCQ) and sulfasalazine (SSLZ), (C) switched MTX from oral administration to subcutaneous injection, (D) discontinued SSLZ and switched to leflunomide, (E) maintained Pd, MTX, HCQ and leflunomide.

Reference

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