Polyarthrite rhumatoïde vieillie avec poumon rhumatoïde: une observation caricaturale

In the elderly, rheumatoid arthritis is defined by an average age of onset over 60 years. Prognosis mainly depends upon functional capacity, evolutionary stage of the disease, onset or no onset of joint malformations. We report the case of a 70-year old female patient with a history of arterial hypertension, hypothyroidism and Sjögren syndrome diagnosed in 2005. The patient was lost to follow-up and hospitalized in our department in 2016 for diffuse polyarthralgies of large joints with biologic inflammatory syndrome. Clinical examination showed cachectic patient (BMI: 17,6Kg/m(2)). She had articular deformations: hand arthritis with a “camel back” appearance and a “cubital gust of wind” appearance (A), claw feet and bilateral progression of hallux valgus (B). Lung auscultation showed diffuse crackling sound in both lungs. The patient didn't have dyspnea. Cardiac auscultation was normal and there were no signs of heart failure. Chest x-ray showed diffuse reticulo-micronodular appearance (C). Chest CT scan showed diffuse infiltrating pneumopathy supporting common interstitial lung disease (ILD) (D). Doppler echocardiography showed moderate pulmonary arterial hypertension 40mmHg. Blood gas test showed hypoxia 81mmHg with a saturation of 96%. The diagnosis of senile rheumatoid arthritis complicated by pulmonary involvement was then retained. Functional prognosis was uncertain due to these very severe joint deformations.