A 70-year-old female was hospitalized for diffuse polyarthralgies of large joints with biologic inflammatory syndrome.

The lady had a history of arterial hypertension, hypothyroidism and Sjogren syndrome – diagnosed in 7 years back.

On examination, the examination showed patient was cachectic (BMI: 17,6Kg/m2). She had articular deformations – hand arthritis with a "camel back" appearance and a "cubital gust of wind" appearance; claw feet and bilateral progression of hallux valgus. Lung auscultation revealed diffuse crackling sound in both lungs. The patient didnt have dyspnea. Cardiac auscultation was normal and there were no signs of heart failure.

Chest x-ray showed diffuse reticulo-micronodular appearance. Chest CT scan showed diffuse infiltrating pneumopathy supporting common interstitial lung disease (ILD). Doppler echocardiography indicated moderate pulmonary arterial hypertension 40mmHg. Blood gas test suggested hypoxia 81mmHg with a saturation of 96%.

The lady was diagnosed with senile rheumatoid arthritis complicated by pulmonary involvement. Functional prognosis was uncertain due to these very severe joint deformations.