A 71-year-old, retired, male farmer received a diagnosis of seropositive RA after developing pain and swelling in hands and wrists 3 years prior to presentation at our clinic. Following a very brief trial of methotrexate, which was discontinued due to GI intolerance, his rheumatoid disease was managed with low-dose prednisone, hydroxychloroquine, and leflunomide. Approximately a year following the onset of joint symptoms, he noticed the onset of progressive dyspnea on exertion and dry cough that was unresponsive to continued treatment with prednisone. He had no history of pulmonary disease and had no other medical problems. There was no history of exposure to any known occupational irritant or birds. He was a former smoker having quit > 40 years prior to presentation, and denied a history of illicit drug use or alcohol abuse. The patient was receiving the following medications at presentation: prednisone, 5 mg bid; naproxen, 375 mg/d; hydroxychloroquine, 200 mg bid; leflunamide, 20 mg/d; and calcium supplementation.