Rheumatoid arthritis Quiz: Ace Your Exams

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A 60-year-old woman comes to her primary care physician because of shortness of breath. Her symptoms started about a year ago and have progressively worsened. She complains of reduced exercise tolerance and now quickly becomes out of breath while jogging or climbing stairs. She has no chronic cough or excessive mucus production. Past medical history is notable for rheumatoid arthritis. She has been inconsistent with follow-up due to a lack of insurance. She has a 35-pack-year smoking history. Vitals are within normal limits. Physical examination reveals swelling and deformation of the bilateral proximal interphalangeal and wrist joints. Ulnar deviation is noted at the metacarpophalangeal joints. Lung auscultation reveals bibasilar inspiratory crackles. Pulmonary function testing yields the following results:

 
 Laboratory value  Result 
 FEV1  91% of predicted 
 FVC  93% of predicted 
 FEV1/FVC Ratio  85% 

Which of the following best describe the pathophysiology of this patient’s condition?

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