Rheumatoid arthritis patients are susceptible to interstitial lung disease, and joint manifestations of rheumatoid arthritis usually precede lung involvements by several years. Organizing pneumonia, as the first manifestation of rheumatoid arthritis, is extremely rare, and its clinical features remain currently unknown. We present a case and a literature review of patients who were pathologically diagnosed with organizing pneumonia first and met the diagnostic criteria of rheumatoid arthritis later. In this review, we observed the following: (1) patients with organizing pneumonia preceding rheumatoid arthritis have a high prevalence of rheumatoid factor or anticyclic citrullinated peptide antibodies; (2) almost all patients developed rheumatoid arthritis within one year after the diagnosis of organizing pneumonia. We suggest that patients with organizing pneumonia and positive for either rheumatoid factor or anticyclic citrullinated peptide antibody should be cautiously followed up regarding the development of rheumatoid arthritis, particularly during the first year after the diagnosis of organizing pneumonia. 1. Introduction Patients with a connective tissue disorder (CTD) are susceptible to lung involvement and some histopathological patterns of interstitial lung disease (ILD), including usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP), organizing pneumonia (OP), and diffuse alveolar damage, which occasionally occur in rheumatoid arthritis (RA) [1–4]. Joint manifestations of RA usually precede lung involvements by several years; however, in less than 10% of cases of RA associated UIP or NSIP, ILD may be the initial manifestation of RA [5, 6]. Alternatively, OP as the initial manifestation of RA is extremely rare, and its clinical features remain unknown. Here we present a case and a literature review of patients who were pathologically diagnosed with OP and met the diagnostic criteria of RA later. 2. Case Report A 58-year-old male with a history of hypertension visited our hospital with nonproductive cough, dyspnea, weight loss, and fever. He had a smoking history of 2 pack cigarettes/day but had stopped smoking since a year. His laboratory results were as follows: leukocytes, 6800/μL; C-reactive protein, <0.03？mg/dL; KL-6, 264？U/mL (normal value, <500？U/mL); antinuclear antibody, <40; rheumatoid factor (RF), 69？U/mL (normal value, <15？U/mL); and anticyclic citrullinated peptide antibody (CCP), 50.9？U/mL (normal value, <4.5？U/mL). Chest computed tomography revealed bilateral multiple nodules, predominantly in the
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