RT Journal Article
SR Electronic
T1 Pulmonary Nodulosis and Aseptic Granulomatous Lung Disease Occurring in Patients with Rheumatoid Arthritis Receiving Tumor Necrosis Factor-α-Blocking Agent: A Case Series
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.090030
DO 10.3899/jrheum.090030
A1 Eric Toussirot
A1 Jean Marie Berthelot
A1 Edouard Pertuiset
A1 Béatrice Bouvard
A1 Philippe Gaudin
A1 Daniel Wendling
A1 José Le Noach
A1 Anne Lohse
A1 Emmanuelle Lecuyer
A1 Le Cri
YR 2009
UL http://www.jrheum.org/content/early/2009/09/30/jrheum.090030.abstract
AB Objective To describe cases of development of pulmonary nodulosis or aseptic granulomatous lung disease in patients with rheumatoid arthritis (RA) receiving anti-tumor necrosis factor-α (TNF-α) therapy. Methods A call for observation of such cases was sent to members of the French “Club Rhumatismes et Inflammation.” The cases had to occur after introduction of TNF-α-blocking therapy. Results Eleven cases were examined: 6 patients were treated with etanercept, 2 with infliximab, and 3 with adalimumab. Pulmonary nodular lesions were observed after a mean treatment period of 23.3 ± 15.3 months. Clinical symptoms were observed in 5 cases. Radiographs or computed tomography of the chest showed single or multiple nodular lesions in 10 cases and hilar adenopathies in 1 case. Biopsy of the nodular chest lesions or mediastinal lymphadenopathies were performed in 8 patients, and revealed typical rheumatoid nodules in 4 cases and noncaseating granulomatous lesions in 4 cases. Mycobacterial or opportunistic infections were excluded for all cases. Outcome was favorable for all the patients, with either discontinuation or maintenance of anti-TNF-α treatment. Conclusion Aseptic pulmonary nodular inflammation corresponding to rheumatoid nodules or non-caseating granulomatous inflammation can occur during anti-TNF-α therapy for RA, mainly etanercept. The mechanism explaining such a reaction is not clear but certainly includes different processes. These cases of pulmonary nodular inflammation generally have a benign course and do not systematically require withdrawal of treatment.