- Caplan's syndrome.

Caplan's syndrome

*Def:-It is is a combination of rheumatoid arthritis and pneumoconiosis that manifests as intrapulmonary nodules.
*Synonyms:- rheumatoid pneumoconiosis.

*Causes:-

It occurs only in patient with both rheumatoid arthritis and pneumoconiosis related to mining dust (coal, asbestos, silica)so occurs in miners (especially those working in anthracite coal-mines), asbestosis, silicosis and other pneumoconioses.

*Clinical picture:-

• Cough.
• Joint swelling and pain.
• Nodules of the skin (rheumatoid nodules).
• Shortness of breath.
• Wheezing.

*Investigations:-

• Chest x-ray:- shows multiple, round, well defined nodules, usually 0.5 - 2.0 cm in diameter, which may cavitate and resemble tuberculosis.
• Joint x-rays show features of rheumatoid arthritis.
• Pulmonary function tests:-may reveal a mixed restrictive and obstructive ventilatory defect with a loss of lung volume and there may also be irreversible airflow limitation and a reduced DLCO.
• Rheumatoid factor titer tests (+ve).

 *Management:-

• Once tuberculosis has been excluded, treatment is with steroids.
• All exposure to coal dust must be stopped
• Smoking cessation should be attempted.
• Rheumatoid arthritis should be treated as usual.
   
  Dr Ibrahim
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