Pulmonary necrobiotic nodules as a presenting feature of rheumatoid arthritis

In rheumatoid disease only 4 cases have been reported in which lung nodules preceded arthritis. Two further cases are presented in which intrapulmonary nodules were noted at the onset of the disease, thus provoking a diagnostic dilemma. In the first patient rheumatoid factor tests were initially negative, and diagnostic thoracotomy was performed. In the second patient serological tests were positive, and biopsy was avoided. It therefore seems that detection of circulating rheumatoid factor in patients with lung shadows can be a useful aid to diagnosis and management.