Caplan Syndrome

In 1953 Dr. Caplan, of the UK Cardiff Pneumoconiosis Medical Panel, recorded that massive pneumoconiosis was commoner in coal-workers suffering from rheumatoid arthritis.. Caplan also noticed that chest radiographs exhibited round, well circumscribed nodules, that sometimes cavitate and resemble tuberculosis. Caplan syndrome is caused by occupational exposure to coal, asbestos, and or silica. Pneumoconiosis and a more extensive inflammatory reactive lung condition to the dust involving joints in the clinical pattern of rheumatoid arthritis. Smoking is believed to aggravate the disease.The incidence of Caplan disease is higher in silicosis. It is strongly associated with progressive massive fibrosis and tuberculosis in those with an established pneumoconiosis. The reported incidence of Caplan syndrome is 1 in every 100,000 people and falling with the decline of the coal industry.

Caplans syndrome  is rheumatoid arthritis , pneumoconiosis  and intrapulmonary nodules on chest X-ray Lung function tests may reveal a mixed restrictive and obstructive ventilatory defect with a loss of lung volume.  The rheumatoid symptoms are a diagnostic criteria. Rheumatoid positive serology (Rheumatoid factor, antinuclear antibodies, and non-organ specific antibodies) may be absent in the serum. Silicosis and asbestosis must be considered in the differential with TB. Once tuberculosis has been excluded, treatment may commence with  steroids. All exposure to coal dust must be stopped, and smoking cessation should be attempted. Rheumatoid arthritis should be treated normally with early use of disease modifying drugs Lung function tests typically a mixed restrictive and obstructive ventilatory defect with a loss of lung volume. Ascultation of the chest may reveal diffuse rales that do not disappear on coughing or taking a deep breath