Organizing Pneumonia as the First Clinical Manifestation of Early Stage Rheumatoid Arthritis Determined by Hand Joints Synovitis Using Magnetic Resonance Imaging

We report the case of a 50-year-old man who presented with organizing pneumonia(OP) as the first manifestation of rheumatoid arthritis (RA). He experienced repeated episodes of pneumonia, which did not respond to several antibiotics. The lymphocyte dominant cell increase in the bronchoalveolar lavagefluid on chest computerized tomography suggested OP. Although he did not present with articular symptoms, magnetic resonance imaging (MRI) revealed synovitisof the hand jointswithout joint erosion, suggesting that this was a case of early stage RA. The MRI may be a useful diagnostic tool in asymptomatic patients with early stage RA.