Background Pulmonary involvement is a common extraarticular feature of rheumatoid arthritis (RA) but early symptomatic manifestations of RA are uncommon. We present 2 male RA patients with all characteristic features of pulmonary involvement which preceded the articular symptoms and occurred concurrently.

Case1; A 32-year-old male presented with severe pulmonary involvement due to the rheumatoid nodules, pleurisy, atelectasis, interstitial fibrosis which preceded the articular symptoms. Case 2; A 54-year-old male presented with articular manifestations of RA associated with typical pulmonary findings of rheumatoid lung including paranchimal nodules, pleurisy, interstitial fibrosis and honey-comb appearance simultaneously. In both cases the diagnosis were made after exclusion of other causes of pulmonary disease and depending on the findings of pleural biopsy.

In conclusion the onset of RA with severe typical pulmonary findings are not uncommon and physicians must be aware of this extraarticular finding as a presenting feature of RA.