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Pulmonary nodulosis and aseptic granulomatous lung disease occurring in patients with rheumatoid arthritis receiving tumor necrosis factor-alpha-blocking agent: a case series.
Toussirot, Eric; Berthelot, Jean Marie; Pertuiset, Edouard; Bouvard, Béatrice; Gaudin, Philippe; Wendling, Daniel; le Noach, José; Lohse, Anne; Lecuyer, Emmanuelle; Cri, Le.
Afiliação
  • Toussirot E; Department of Rheumatology, University Hospital Jean Minjoz, EA 3186 Agents Pathogènes et Inflammation, IFR 133 University of Franche-Comté, CIC Biotherapy 506, St. Jacques Hospital, Besançon, France. etoussirot@chu-besancon.fr
J Rheumatol ; 36(11): 2421-7, 2009 Nov.
Article em En | MEDLINE | ID: mdl-19797509
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-alpha (TNF-alpha) 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-alpha-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-alpha treatment. CONCLUSION: Aseptic pulmonary nodular inflammation corresponding to rheumatoid nodules or noncaseating granulomatous inflammation can occur during anti-TNF-alpha 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.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Artrite Reumatoide / Fator de Necrose Tumoral alfa / Antirreumáticos / Granuloma / Pneumopatias Idioma: En Ano de publicação: 2009 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Artrite Reumatoide / Fator de Necrose Tumoral alfa / Antirreumáticos / Granuloma / Pneumopatias Idioma: En Ano de publicação: 2009 Tipo de documento: Article