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Rheumatoid arthritis causing diffuse alveolar haemorrhage: a novel therapeutic approach
  1. Afaf Osman1,
  2. Panagis Galiatsatos2,3,
  3. Sonali Bose3,
  4. Sonye Danoff3
  1. 1Department of Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
  2. 2Department of Critical Care Medical, National Institutes of Health, Bethesda, Maryland, USA
  3. 3Division of Pulmonary and Critical Care, Johns Hopkins Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Panagis Galiatsatos, panagis.galiatsatos{at}


Pulmonary vascular involvement due to rheumatoid arthritis, presenting as diffuse alveolar haemorrhage (DAH), is a rare phenomenon, especially if there are no signs of systemic vasculitides. Furthermore, how to proceed with the management of these patients is challenging, as in the case of our patient, who had recurrent DAH. We present a case of a patient with known rheumatoid arthritis who had recurrence of DAH that spanned over several years, often presenting with life-threatening respiratory failure. While her DAH presentation improved with high-dose glucocorticoids, to resolve her recurrence, we opted to initiate treatment with rituximab, with a short course of azathioprine. After the second round of rituximab, the patient continues to do well without any further DAH-related complications. We also summarise prior cases of such patients to highlight variable treatment options.

  • Interstitial lung disease
  • Connective tissue disease
  • Rheumatoid arthritis
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  • Contributors AO and PG both prepared the manuscript and cared for the patient. SB and SD both cared for the patient and oversaw the completion of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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