When should I consider referring a patient with rheumatoid lung disease to a respiratory specialist?

Consider referring a patient with rheumatoid lung disease to a respiratory specialist when they present with persistent respiratory symptoms such as breathlessness on exertion, persistent cough, or abnormal chest signs including bilateral inspiratory crackles or finger clubbing. These features may indicate interstitial lung involvement or other complications requiring specialist assessment.

Referral is particularly important if initial investigations such as chest X-ray or lung function tests (spirometry and gas transfer) suggest restrictive or other abnormal patterns, or if there is diagnostic uncertainty. A multidisciplinary team with expertise in interstitial lung disease should be involved for diagnosis and management.

Additionally, urgent referral should be considered if there are features raising suspicion of malignancy (e.g., unexplained chest pain, weight loss, or persistent cough in patients over 40 years, especially with a smoking history), to exclude lung cancer or mesothelioma.

Early specialist involvement is also warranted to discuss management options including immunosuppressive therapy, monitoring for disease progression, and consideration of lung transplantation assessment if appropriate.

In summary, refer to a respiratory specialist when rheumatoid lung disease is suspected or confirmed with significant symptoms, abnormal imaging or lung function, diagnostic uncertainty, or suspicion of malignancy, to ensure comprehensive multidisciplinary evaluation and management.

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