Pulmonary nodule and aggressive tibialis posterior tenosynovitis in early rheumatoid arthritis

We report the case of a 34-year-old man with a rheumatoid pulmonary nodule preceding the development of articular symptoms of rheumatoid arthritis. Pu lmonary nodules are a well known feature of rheumatoid arthritis and are mo stly seen in severe established rheumatoid factor-positive cases. To differ entiate between benign and malign pulmonary nodules we discuss the use of p ositron emission tomography (PET). Despite intensive therapy with steroids and methotrexate in our patient, within months he developed a severe tibial is posterior tendinitis, with partial rupture and evolution to a planovalgu s deformity requiring surgery. Both these symptoms are rare but demonstrate the need for close follow-up in early rheumatoid arthritis.