Mounting Challenges: A Tragic Case of Rheumatoid Arthritis-Associated Interstitial Lung Disease in an Incarcerated Patient, Highlighting Healthcare Access Barriers in Correctional Settings
Year: 2026
Type: article
Study design: Case Report
Abstract: Rheumatoid Arthritis-associated Interstitial Lung Disease (RA-ILD) is a serious extra-articular manifestation associated with significant morbidity and mortality. We present the case of a 48-year-old incarcerated male with seropositive rheumatoid arthritis who was clinically stable on tofacitinib and methotrexate for over one year. Following the discontinuation of tofacitinib, which the patient attributed to correctional facility formulary changes and restrictions, he developed progressive respiratory symptoms. He presented to the hospital two months later with acute hypoxic respiratory failure necessitating intubation. Computed tomography of his lungs revealed extensive ground-glass opacities with honeycombing consistent with usual interstitial pneumonia pattern ILD, a condition previously undiagnosed in this patient. Despite aggressive management including pulse-dose corticosteroids, bronchoscopy, empiric antimicrobial treatment and comprehensive infectious workup, he continued to deteriorate over an eight-day intensive care unit course. He was deemed not a candidate for extracorporeal membrane oxygenation or lung transplantation due to acute illness severity, and the family eventually elected to transition to comfort care. This case highlights the profound challenges of managing rheumatoid arthritis in incarcerated populations, including barriers to accessing expensive targeted therapies, limited specialist availability, and the importance of treatment continuity for patients with complex autoimmune diseases. We discuss the practical implications of these healthcare disparities and advocate for policy reforms to ensure adequate rheumatologic care in correctional settings.
Source: Cureus
Author: Shaivya Pathak
Institution: East Carolina University
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7126103101