Rheumatoid lung changes associated with asbestosis

Our plain-English summary of Rheumatoid lung changes associated with asbestosis, by A.G. Rickards, G.M. Barrett (Thorax, 1958).

The study

• Authors: A.G. Rickards, G.M. Barrett
• Journal: Thorax
• Published: 1958;13(3):185-93
• Cited by: 28 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 002677).

In plain English

This 1958 article was a case report with a review of earlier published cases of rheumatoid lung disease. The patient was a 49-year-old man with rheumatoid arthritis who had worked as a general labourer in an asbestos factory from January 1952 to January 1956. The article does not name the type of asbestos. He was admitted to hospital in November 1956 and died five days later of circulatory failure attributed to influenzal pneumonia. At necropsy both lungs were much heavier than normal (850 and 900 g). Microscopy showed generalized asbestosis with a diffuse interstitial pneumonitis. Nodular abscesses in the middle and lower zones proved to be necrobiotic foci of rheumatoid disease. Asbestosis bodies inside these foci were distributed much as in the surrounding lung. The authors took this to suggest the lesions were not much older than nine months, the interval between death and last dust exposure. The authors described this as the first case of its kind recorded. Drawing on earlier reports, they suggested that silica particles may play a more important part than pre-formed collagen in producing these lesions.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report (one patient, with necropsy), plus a review of previously published cases of lung disease in rheumatoid arthritis
• Who was studied: One 49-year-old man with rheumatoid arthritis, seen at the Royal Infirmary, Lancaster, and first seen in October 1956. He had worked as a general labourer and 'spare hand' in an asbestos factory.
• Exposure: Work as a general labourer in an asbestos factory from January 1952 to January 1956. At this factory, calcined diatomaceous earth from a local deposit was mixed with asbestos. The authors judged he must have been exposed to a very high dust concentration during indoor duties. The asbestos fiber type is not stated.
• Main results:
  • The patient was admitted as an emergency on November 14, 1956. He died five days later in peripheral circulatory failure attributed to influenzal pneumonia.
  • At necropsy both lungs were much heavier than normal, weighing 850 g and 900 g.
  • Microscopy of the lungs showed generalized asbestosis with diffuse interstitial pneumonitis.
  • The nodular abscesses in the middle and lower zones were rheumatoid necrobiotic foci. At necropsy they had first been thought probably tuberculous. Smaller and less frequent foci were found in the upper lobes.
  • Asbestos particles and asbestosis bodies were seen within the necrotic areas, distributed in a way not noticeably different from the surrounding lung tissue. The authors took this to suggest the lesions were of relatively recent occurrence, not much older than nine months. Nine months was the interval between death and last exposure to dust.
  • Review of earlier published reports (not this study's own patients): of 26 previously described cases with necrobiotic rheumatoid lung lesions, 15 were associated with pneumoconiosis.
• The authors' conclusion: The authors stated this was the first such case recorded. They suggested that silica particles themselves may play a more important part than pre-formed collagen in producing these necrobiotic lesions. They also suggested that the chemical action of dust particles may be the exciting factor in the pneumoconiotic group of cases.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Related studies

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• Occupations and exposures in the work environment as determinants for rheumatoid arthritis — A.R. Olsson, T. Skogh, et al. (2004)
• Association of Agricultural, Occupational, and Military Inhalants With Autoantibodies and Disease Features in US Veterans With Rheumatoid Arthritis — A.V. Ebel, G. Lutt, et al. (2021)
• Paraneoplastic Migratory Oligoarthritis in a Patient With Malignant Mesothelioma — M. Eidenschink, A. Beard, et al. (2019)
• Pulmonary changes after exposure to vermiculite contaminated with fibrous tremolite — J.E. Lockey, S.M. Brooks, et al. (1984)
• Decline in annual lung function in workers exposed to asbestos with and without pre-existing fibrotic changes on chest radiography — T. Nakadate (1995)

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