ABSTRACT
Resumen Históricamente, los estudios de campo observacionales han sido el punto de partida para el desarrollo de grandes avances en el entendimiento de las enfermedades autoinmunes. En el caso de la artritis reumatoide (AR), se han descrito varias asociaciones clínicas hasta la actualidad que tienen en común modelos inmunológicos transversales a la historia natural de la misma, lo que ha permitido avanzar en el desarrollo de nuevos objetivos terapéuticos. Se pretende hacer una breve descripción del compromiso nodular en AR, partiendo de las observaciones clínicas del Dr. Anthony Caplan en pacientes con riesgo de neumoconiosis, con el fin de reconocer el valor de este tipo de asociaciones en el ejercicio médico profesional.
Historically, observational field studies have been the starting point for the development of great advances in the understanding of autoimmune diseases. In the case of rheumatoid arthritis (RA), several clinical associations have been described to date which have in common immunological models transverse to its natural history, which has allowed progress in the development of new therapeutic objectives. Our aim is to make a brief description of nodular involvement in RA, based on the clinical observations of Dr. Anthony Caplan in patients at risk of pneumoconiosis, in order to recognize the value of this type of association in professional medical practice.
Subject(s)
Humans , Male , Middle Aged , Caplan Syndrome/diagnosis , Arthritis, Rheumatoid , Autoimmune Diseases , Caplan Syndrome/physiopathology , Caplan Syndrome/history , Caplan Syndrome/therapy , Radiography, Thoracic , Lung Diseases, InterstitialABSTRACT
Apesar de rara, a pneumoconiose reumatoide, também chamada de síndrome de Caplan, pode ser diagnosticada entre trabalhadores expostos à sílica e entre pacientes com silicose, pneumoconiose dos mineiros de carvão e asbestose. A maior prevalência ocorre entre os silicóticos, apesar de ter sido descrita inicialmente em mineiros de carvão com pneumoconiose. O achado que define o tipo clássico da síndrome é a presença de nódulos reumatoides nos pulmões, independente da presença ou não de pequenas opacidades pneumoconióticas, ou de grandes opacidades de fibrose pulmonar maciça, associada ou não a um quadro de artrite reumatoide em atividade. Relatamos o caso de uma mulher com quadro de artrite reumatoide, diagnosticada 34 anos após exposição à sílica livre em uma indústria de porcelana por 7 anos, apresentando radiograma de tórax com opacidades arredondadas de 1 a 5 cm de diâmetro, distribuídas na periferia de ambos os pulmões. A biópsia transtorácica guiada por TC de um dos nódulos revelou tratar-se de nódulo reumatoide com macrófagos em paliçada, típico da síndrome de Caplan. São discutidos aspectos de diagnóstico da síndrome, classificação e ocorrência, ressaltando a importância da anamnese ocupacional em casos de artrite reumatoide com opacidades radiológicas pulmonares.
Although rare, rheumatoid pneumoconiosis, also known as Caplan's syndrome, can occur in workers exposed to silica, as well as in patients with silicosis, coal workers' pneumoconiosis or asbestosis. Prevalence is higher among patients with silicosis, despite the fact that it was originally described in coal workers with pneumoconiosis. The classical finding that defines this syndrome is that of rheumatoid nodules in the lungs, regardless of whether there are small rounded opacities suggestive of pneumoconiosis or large opacities consistent with massive pulmonary fibrosis, with or without clinical rheumatoid arthritis. We describe the case of a female patient with rheumatoid arthritis, diagnosed 34 years after 7 years of occupational exposure to silica at a porcelain plant. A chest X-ray showed circular opacities of 1-5 cm in diameter, bilaterally distributed at the periphery of the lungs. A CT-guided thoracic punch biopsy of one of those nodules revealed that it was rheumatoid nodule surrounded by a palisade of macrophages, which is typical of Caplan's syndrome. Aspects of diagnosis, classification and occurrence of this syndrome are discussed, emphasizing the importance of the occupational anamnesis of patients with rheumatoid arthritis and lung opacities on chest X-rays.