10th September 2020

A 55-year-old man presents with progressive exertional dyspnoea and a non-productive cough for 3 months

A 55-year-old man presents with progressive exertional dyspnoea and a non-productive cough for 3 months. There are no red flag features of haemoptysis or weight loss, and he has never smoked in his life. His past medical history includes rheumatoid arthritis diagnosed 6 years ago and is being managed on methotrexate for this. Examination reveals swollen MCP and PIP joints of both hands, digital clubbing and auscultation reveals bi-basal fine end-inspiratory crackles. Spirometry results show a FEV₁/FVC ratio of 82%.

For the patient above, please select the SINGLE most likely diagnosis. Select ONE option from the list above.