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Clinical and Radiological Features of Acute-Onset Diffuse Interstitial Lung Diseases in Patients with Rheumatoid Arthritis Receiving Treatment with Biological Agents: Importance of Pneumocystis Pneumonia in Japan Revealed by a Multicenter Study
- Source :
- Internal Medicine. 50:305-313
- Publication Year :
- 2011
- Publisher :
- Japanese Society of Internal Medicine, 2011.
-
Abstract
- Objective Acute-onset diffuse interstitial lung disease (AoDILD) in patients with rheumatoid arthritis (RA) has been a serious concern, especially for those under treatment with biological agents which may affect the presentation and outcome of AoDILD, including Pneumocystis pneumonia (PCP). Therefore, we conducted a retrospective, multi-center study of AoDILD in RA patients receiving biological agents. Methods Patients who developed AoDILD while receiving biological agents (infliximab, etanercept, adalimumab and tocilizumab) were enrolled in the study. Definite PCP was defined as patients who showed either P. jirovecii organisms in their respiratory samples by microscopic examination, or positive tests for both P. jirovicii DNA-PCR with respiratory samples and an elevated serum 1,3-β-D-glucan level above the cut-off value. Probable PCP was defined as either a positive test for P. jirovicii PCR or an elevated serum β-D-glucan level. Chest HRCT findings were evaluated and scored by two board-certified radiologists. Results The final diagnoses for 26 patients examined were definite PCP for 13 patients, probable PCP for 11, and methotrexate-associated pneumonitis in 2 patients. Definite and probable PCP cases were clinically indistinguishable. Generalized, diffuse ground-glass opacity (GGO) is the characteristic HRCT finding in patients with definite or probable PCP, which was different from our previous findings in RA patients, mostly without biologics, showing GGO distributed in a panlobular or multilobular manner. The clinical outcome was favorable by treatment with trimethoprim-sulfamethoxazole and glucocorticoids. Conclusion The possibility of PCP should be intensively investigated in RA patients developing AoDILD while receiving biological agents.
- Subjects :
- Pathology
medicine.medical_specialty
business.industry
Interstitial lung disease
General Medicine
medicine.disease
Pneumocystis pneumonia
Gastroenterology
Infliximab
respiratory tract diseases
Etanercept
Pneumonia
chemistry.chemical_compound
Tocilizumab
chemistry
Internal medicine
Internal Medicine
medicine
Adalimumab
business
medicine.drug
Pneumonitis
Subjects
Details
- ISSN :
- 13497235 and 09182918
- Volume :
- 50
- Database :
- OpenAIRE
- Journal :
- Internal Medicine
- Accession number :
- edsair.doi...........b12324f402c09ee1ec3c357cbab596c7