COLD-INDUCED PULMONARY-DISEASE - CLINICAL-FEATURES, OUTCOME, AND DIFFERENTIATION FROM RHEUMATOID LUNG-DISEASE

Gold-induced pulmonary disease is difficult to diagnose, especially, i n the case in which interstitial pneumonia appears in the course of go ld therapy for rheumatoid arthritis. We analyzed the literature to def ine the clinical features and prognosis of gold-induced pulmonary dise ase, and to identify those features that distinguish gold-induced pulm onary disease from pulmonary disease secondary to the underlying disea se process of rheumatoid arthritis. Relevant articles from the medical literature were identified using a Medline search, and the bibliograp hies of the articles were retrieved. These works were critically revie wed for information on the clinical, physiologic, radiographic, pathol ogic, and bronchoalveolar lavage (BAL) findings. A total of 140 cases of gold-induced pulmonary disease were identified from 110 reports. In 81% of the patients, gold was being used to treat rheumatoid arthriti s, bronchial asthma (6%), pemphigus (5%), or other processes (9%). Sid e effects other than pulmonary toxicity were common, and included skin rash (38%), peripheral eosinophilia (38%), liver dysfunction (15%), a nd proteinuria (22%). Only the presence of pemphigus or liver dysfunct ion correlated with a bad prognosis. Cold-induced pulmonary disease mo st often followed improvement in rheumatoid arthritis, presumably indu ced by gold therapy. BAL lymphocytosis and computed tomography (CT) sc an findings are useful in making a diagnosis of gold-induced pulmonary disease in an appropriate clinical setting. Features that distinguish gold-induced pulmonary disease from rheumatoid lung disease include f emale predominance, presence of fever or skin rash, absence of subcuta neous nodules or finger clubbing, low titers of rheumatoid factor at o nset of lung disease, lymphocytosis in bronchoalveolar lavage fluid (B ALF), and alveolar opacities along the bronchovascular bundles on ches t CT scan. Gold-induced lung disease is a distinct entity that can be distinguished from rheumatoid lung disease. It usually improves with c essation of therapy or treatment with corticosteriods.