Having in mind the frequent asymptomatic nature of coal worker's pneumoconiosis (CWP) or silicosis, the principal occupational factors in the pathogenesis of Caplan syndrome, patients often present with little or no respiratory symptoms [1] [2]. Mild dyspnea, most notably on exertion, was noted as the principal complaint in recent case reports [1] [2], while a cough and hemoptysis are absent. In fact, the disease is often discovered incidentally, while virtually all patients present with one or more manifestations of rheumatoid arthritis (RA) [2] [3]:

• Polyarthritis, tendinitis, bursitis - Most commonly involving the wrist and hand joints; profound inflammation seen in RA causes polyarthritis accompanied by morning stiffness, usually in a symmetrical fashion.
• Nodules - Firm, nontender nodules that develop most frequently in the forearms, calfs, and the sacrum, are one of the main features of RA, and their subcutaneous appearance may be followed by their development in visceral organs, including the lungs, which is the cardinal feature of Caplan syndrome.
• Constitutional symptoms - Fever, fatigue, malaise and cachexia ensue as a result of extensive inflammatory changes.

Although seen in a very small number of patients, cardiac (ischemic heart disease, cardiomyopathy, pericarditis) and hematologic (anemia, neutropenia, splenomegaly) features may also be encountered in RA patients [3].

• Severe Pain

  pain in the inner corner of the eye disproportionate to the degree of ocular inflammation, pain in the root of the nose, tearing, and ipsilateral nasal watery discharge believed to be due to irritation of the ciliary ganglion CH�DIAK-HIGASHI SYNDROME [rxpgonline.com]

• Vietnamese

  Русский (Russian) ಕನ್ನಡ (Kannada) 한국어 (Korean) עברית (Hebrew) Український (Ukrainian) اردو (Urdu) Magyar (Hungarian) मानक हिन्दी (Hindi) Indonesia (Indonesian) Italiano (Italian) தமிழ் (Tamil) Türkçe (Turkish) తెలుగు (Telugu) ภาษาไทย (Thai) Tiếng Việt (Vietnamese [synonyms.com]

• Cough

  Examination should reveal tender, swollen metacarpophalangeal joints and rheumatoid nodules ; auscultation of the chest may reveal diffuse râles that do not disappear on coughing or taking a deep breath. [en.wikipedia.org]

  Examination of the chest may show diffuse rales that do not disappear on coughing or taking a deep breath. [patient.info]

  Clinical findings Swollen joints, rheumatoid nodules, cough and dyspnoea. [medical-dictionary.thefreedictionary.com]

• Dyspnea

  Mild dyspnea, most notably on exertion, was noted as the principal complaint in recent case reports, while a cough and hemoptysis are absent. [symptoma.com]

  Review Topic QID: 100904 4 Malignant pulmonary mesothelioma M1 Select Answer to see Preferred Response PREFERRED RESPONSE 5 (M1.PL.118) A 42-year-old male presents to your office complaining of dyspnea on exertion. [medbullets.com]

  Once the disease progresses, patients can develop dyspnea that is typically progressive. If left untreated, patients can develop signs of right-sided heart failure. [lecturio.com]

  She came to the Bayview ER, complaining of dyspnea on exertion (DOE), a worsening cough from her baseline and saturating about 78 to 80% on room air. A week before the onset of these symptoms, she had a low-grade fever. [hopkinsarthritis.org]

• Rales

  Examination of the chest may show diffuse rales that do not disappear on coughing or taking a deep breath. [patient.info]

• Chronic Cough

  Patients with unexplained weight loss, fever, night sweats and chronic cough might have a superimposed mycobacterial infection and specific treatment for mycobacterial infection should be started. [lecturio.com]

  Case 3 The woman who had a chronic cough and a high-resolution CT that showed some bronchial thickening. She was obstructive. DLCO was also diminished. [hopkinsarthritis.org]

• Productive Cough

  She did have a non-productive cough, but it was much of a problem for her. She was certainly saturating less than 90% on room air. Her DLCO was right at 71% predicted, and her white count was 8,000. [hopkinsarthritis.org]

  Patients with simple CWP can be asymptomatic or can present with non-specific symptoms such as a productive cough. Once the disease progresses, patients can develop dyspnea that is typically progressive. [lecturio.com]

• Joint Tenderness

  joints, tender joints, ESR/CRP and self-assessment (out of 10) Note does not include feet, ankles or neck >5.1 = high disease activity 3.2-5.1 = moderate Management of rheumatoid arthritis Conservative management Patient education and early involvement [oxfordmedicaleducation.com]

• Short Arm

  Yet in the last two decades as many as 124 different HLA antigens determined by at least 7 very closely linked genes located on the short arm of chromosome 6 have been identified and subsequently agreed upon by an international nomenclature committee. [books.google.com]

Because Caplan syndrome is strongly associated with occupational exposure to coal dust or silica, a detailed patient history with an emphasis on previous occupations may be one of the most important steps during workup. Similarly, assessment of signs and symptoms suggestive of RA (if the diagnosis is not already known) can only be made after a meticulous history taking, but the role of a thorough physical examination is equally important. The diagnosis of Caplan syndrome, however, relies on findings obtained from imaging studies - radiography and computed tomography (CT) of the thorax [4] [5]. Well-defined lung nodules that range from 0.5-5 cm, predominantly located in the periphery, are typical radiographic lesions seen in these patients [1] [4]. Coalescence of nodules and formation of a large confluent nodule, cavitation or calcification may also be observed [4]. On the other hand, confirmation of RA is necessary by performing appropriate laboratory tests, in addition to clinical criteria. Evaluation of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies are mandatory if clinical suspicion toward RA exists. The combination of radiographic findings, occupational risk factors, and laboratory results should be sufficient to make the diagnosis of Caplan syndrome.

• Pulmonary Infiltrate

  Rheumatoid arthritis extra-articular manifestations : • arm paresthesias and hyperreflexia → C1-C2 subluxation (increased risk with intubation) • cough, fever, pulmonary infiltrates → bronchiolitis obliterans organizing pneumonia • foot drop or wrist [mnemocine.wordpress.com]

• Kerley A Lines

  カーリー Kerley B line カーリーのB線 Kernig ケルニッヒ Kernig's sign ケルニッヒ徴候 Kienboeck キーンベック Kienboeck's disease キーンベック病 RobertKienböck （1871-1953） Austrian radiologist Kiesselbach キーゼルバッハ Kiesselbach area キーゼルバッハ部位 Killian キリアン Killian operation キリアン手術 Kimmelstiel-Wilson [jams.med.or.jp]

• Restrictive Pulmonary Function

  Pulmonary function tests show a restrictive pattern with a reduced DLCO and BAO and usually show a lymphocytic infiltrate. [hopkinsarthritis.org]

Physical treatment should proceed as for rheumatoid arthritis (RA). Smoking should cease. Drugs After exclusion of TB, steroids are used. Treatment of the RA will include disease-modifying anti-rheumatic drugs (DMARDs) at an early stage. [patient.info]

AutoimmuneMom.com is not a medical practice and does not provide medical advice, diagnosis, or treatment. [autoimmunemom.com]

Treatment of Caplan’s Syndrome or Coal Workers Pneumoconiosis No particular cure is available for the treatment of Caplan’s syndrome. [epainassist.com]

Treatment is symptomatic; disease-specific treatment is currently unavailable. Prevention remains to be the most important measure. [eestiarst.ee]

Prognosis [ edit ] The nodules may pre-date the appearance of rheumatoid arthritis by several years. Otherwise prognosis is as for RA; lung disease may remit spontaneously, but pulmonary fibrosis may also progress. [en.wikipedia.org]

Prognosis The nodules may pre-date the appearance of rheumatoid arthritis by several years. Otherwise prognosis is as for RA; lung disease may remit spontaneously, but pulmonary fibrosis may also progress. [ipfs.io]

Prognosis This is as for RA. Severe respiratory disability is uncommon but massive pulmonary fibrosis can progress at times. Spontaneous remission of the lung disease can occur. [patient.info]

Etiology is unknown, but autoimmune mechanisms have been implicated. [termsciences.fr]

• A chronic inflammatory disease of unknown etiology marked by a symmetric, peripheral polyarthritis. • Most common form of chronic inflammatory arthritis 3. • A systemic Disease • Extraarticular manifestations : 1. [slideshare.net]

Its etiology is unknown. It has a male-to-female ratio in RA and otherwise of about 1 to 1, but it’s questionable whether there’s a female predominance. [hopkinsarthritis.org]

Anthony Newman Taylor, Paul Cullinan, Paul Blanc, Anthony Pickering CRC Press, ٢٥‏/١١‏/٢٠١٦ - 547 من الصفحات This authoritative text on occupational lung disorders builds upon the fundamentals, including clinical, epidemiological, and predictive approaches [books.google.com]

Epidemiology It was said to affect 1 in 100,000 people but the incidence is falling as the coal mining industry has been in decline. The prevalence is so low that much of the literature is case reports rather than trials. [patient.info]

Epidemiology [ edit ] Incidence is currently 1 in 100,000 people but is likely to fall as the coal mining industry declines. It has also been shown to occur in cases of complicated silicosis (marked by progressive massive pneumoconiosis). [en.wikipedia.org]

This review summarizes history, definition and current knowledge on epidemiology, pathology, pathophysiology, clinical presentation and treatment of Caplan's syndrome. Copyright 2010 European Federation of Internal Medicine. [ncbi.nlm.nih.gov]

Pathophysiology [ edit ] The presence of rheumatoid arthritis alters how a person's immune system responds to foreign materials, such as dust from a coal mine. [1] When a person with rheumatoid arthritis is exposed to such offensive materials, they are [en.wikipedia.org]

This review summarizes history, definition and current knowledge on epidemiology, pathology, pathophysiology, clinical presentation and treatment of Caplan's syndrome. Copyright 2010 European Federation of Internal Medicine. [ncbi.nlm.nih.gov]

Pathophysiology The presence of rheumatoid arthritis alters how a person's immune system responds to foreign materials, such as dust from a coal mine. [1] When a person with rheumatoid arthritis is exposed to such offensive materials, they are at an increased [ipfs.io]

The most important task of occupational health care is prevention of occupational and occupation-related diseases. Preventive medical examinations are important for detecting diseases at early stages. [ujoh.org]

Prevention remains to be the most important measure. The article describes a case of rheumatoid pneumoconiosis in a patient in whom specific radiological changes were revealed during routine screening. [eestiarst.ee]

Prevention People with rheumatoid arthritis (RA) must not be exposed to additional risk factors for lung disease. [patient.info]

The antibiotics were given to prevent an infection of the damaged heart. However, antibiotics are now used much less often. You may need to limit activity that requires more work from your heart. Talk to your provider. [mclaren.org]

Prevention People with rheumatoid arthritis should avoid exposure to hazardous dust. [coordinatedhealth.com]

1. De Capitani EM, Schweller M, Silva CM, Metze K, Cerqueira EM, Bértolo MB. Rheumatoid pneumoconiosis (Caplan's syndrome) with a classical presentation. J Bras Pneumol. 2009;35(9):942-946.
2. Rozenberg D, Shapera S. What to do with all of these lung nodules? Can Respir J. 2014;21(3):e52-e54.
3. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012
4. Schreiber J, Koschel D, Kekow J, Waldburg N, Goette A, Merget R. Rheumatoid pneumoconiosis (Caplan's syndrome). Eur J Intern Med. 2010;21(3):168-72.
5. Arakawa H, Honma K, Shida H, Saito Y, Morikubo H. Computed tomography findings of Caplan syndrome. J Comput Assist Tomogr. 2003;27(5):758-760..