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Boudal AM, Alsaigh RG, Alrajhi NN, Idrees MM, Omair MA, Al Rayes HM, Alaithan MA, Alhamad EH, Alqahtani NH, Bohuliga KG, Alenezi NY, Alharbi FA. Exploring rheumatoid arthritis associated interstitial lung disease a retrospective study from two Saudi tertiary care centers. BMC Rheumatol 2024; 8:32. [PMID: 39103942 PMCID: PMC11299410 DOI: 10.1186/s41927-024-00403-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 07/24/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Interstitial lung disease (ILD) is an increasingly recognized complication of rheumatoid arthritis (RA) and is associated with significant morbidity and mortality. Many risk factors for RA-related ILD were reported. The current study aims to explore the features and risk factors of Saudi patients with RA-ILD. METHODS This is a multicenter, retrospective, observational study of patients with RA-ILD. Clinical and radiological data from patients with RA-ILD were obtained from electronic medical records, including demographics, clinical characteristics, laboratory tests, pulmonary function tests, ECHO, and HRCT images. RESULT Out of 732 patients, 57 had RA-ILD. The mean age at the time of ILD diagnosis was 61.9 (± 12.2) years. RA-ILD diagnosis was significantly less among females (p = 0.008). Patients who ever smoked had significantly more RA-ILD (p < 0.001). Patients with RA-ILD were more likely to present with medical comorbidities, namely diabetes (p < 0.001), hypertension (p < 0.001), ischemic heart disease (p < 0.001), and osteoarthritis (p = 0.030). The multivariate analysis revealed that the age (OR: 1.035, 95% CI: 48.45-52.86, p = 0.0001); gender (OR: 2.581, CI: 1.77-1.86, p = 0.001), DM (OR: 2.498, 95% Cl: 1.65-1.76, P = 0.0001), HTN (OR: 1.975, 95% Cl: 1.61-1.74, P = 0.019), IHD (OR: 6.043, 95% Cl: 1.89-1.93, P = 0.0001) have a significant positive association with RA-ILD. No significant differences were observed between seropositive parameters with or without RA-ILD (p > 0.05). The most common symptoms of RA-ILD were cough (55.6%) and dyspnea (30.2%), and the most common ILD pattern was Non-specific Interstitial Pneumonia (NSIP) (55.6%) followed by Usual Interstitial Pneumonia (UIP) (38.9%). Traction bronchiectasis (75.5%) and glass ground opacities (73.6%) were also observed. The mean FVC and DLCO at baseline were 64.6% and 53.3%, respectively. CONCLUSION In this cohort of patients, Saudi RA-ILD patients had a predominant NSIP pattern conversely to what is seen globally. These findings could be explained by the lower rates of smoking in our patient population. Future prospective national studies are needed to confirm the current findings and better evaluate RA-ILD epidemiology and risk factors.
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Affiliation(s)
- Ayah M Boudal
- Rheumatology Unit, Department of Medicine, King Abdullah Medical Complex, Jeddah, Saudi Arabia.
| | - Rafif G Alsaigh
- Rheumatology Unit, Department of Medicine, Hera General Hospital, Makkah, Saudi Arabia
| | - Nuha N Alrajhi
- Division of Pulmonary Medicine, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Majdy M Idrees
- Division of Pulmonary Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed A Omair
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hanan Mohammed Al Rayes
- Division of Rheumatology Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mufaddal Adil Alaithan
- Division of Rheumatology Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Esam H Alhamad
- Division of Pulmonary Medicine, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nayef Hadi Alqahtani
- Chest Radiology, Department of Radiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Nawaf Y Alenezi
- Pulmonary Division, Department of Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Fawaz A Alharbi
- Division of Pulmonary Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Matson SM, Demoruelle MK. Connective Tissue Disease Associated Interstitial Lung Disease. Rheum Dis Clin North Am 2024; 50:423-438. [PMID: 38942578 DOI: 10.1016/j.rdc.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Connective tissue disease associated interstitial lung disease (CTD-ILD) is a heterogenous collection of conditions with a diverse spectrum of interstitial lung disease (ILD) manifestations. Currently, clinical practice of lung-directed immunosuppression in CTD-ILD is supported by several randomized, placebo-controlled trials (RCTs) in patients with scleroderma and several observational, retrospective studies in other autoimmune conditions. However, given the harm of immunosuppression in idiopathic pulmonary fibrosis, there is an urgent need for RCTs of immunosuppression and antifibrotic agents in fibrotic CTD-ILD populations as well as the study of intervention in patients with subclinical CTD-ILD.
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Affiliation(s)
- Scott M Matson
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas School of Medicine, 3901 Rainbow boulevard, Mailstop 3007, Kansas City, KS 66160, USA
| | - M Kristen Demoruelle
- Division of Rheumatology, University of Colorado School of Medicine, 1775 Aurora Court, Mail Stop B-115, Aurora, CO 80045, USA.
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Otsuji N, Sugiyama K, Owada T, Arifuku H, Koyama K, Hirata H, Fukushima Y. Safety of Tocilizumab on Rheumatoid Arthritis in Patients with Interstitial Lung Disease. Open Access Rheumatol 2024; 16:127-135. [PMID: 38883149 PMCID: PMC11179650 DOI: 10.2147/oarrr.s462662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/23/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose The prognosis of rheumatoid arthritis (RA) with interstitial lung disease (ILD) is particularly poor. Although drugs that do not contribute to the progression of ILD should be used in RA treatment, none have been established. This study evaluated the safety of tocilizumab in terms of ILD activity. Patients and Methods This study prospectively enrolled all 55 patients with RA complicated by ILD who were treated with tocilizumab at Dokkyo Medical University Saitama Medical Center from April 2014 to June 2022. The outcome measures were MMP-3 and KL-6 as biomarkers of RA and ILD activity, respectively, and the relationship between them was analyzed. Results Both MMP-3 and KL-6 were significantly improved at 6 months of treatment (P < 0.001 and P < 0.05, respectively), and a weak correlation between MMP-3 and KL-6 was observed (R2 = 0.086, P = 0.087). The group with increased MMP-3 due to RA progression had significantly higher KL-6 at 6 months compared with the group with RA improvement (P < 0.05). Also, the group with ILD progression on computed tomography had significantly higher MMP-3 compared with the groups with improvement or no change of ILD (P < 0.05 and P < 0.01, respectively). The mortality rate was 0% at 6 months, 2.0% at 1 year, 16.7% at 2 years, and 32.4% at 3 years, and mortality from acute exacerbation of ILD due to respiratory infection increased over time. Conclusion RA activity and ILD activity were found to be related at 6 months of treatment. Tocilizumab does not seem to affect the mechanism of ILD progression, as most patients showed improvement in both MMP-3 and KL-6 with tocilizumab within 6 months, when this drug would be expected to affect the lungs directly. However, respiratory infection exacerbated ILD from 1 year after the start of treatment. As immunosuppressive drugs, including tocilizumab, have a risk of respiratory infection, it is important to identify early signs of infection.
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Affiliation(s)
- Naotatsu Otsuji
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Kumiya Sugiyama
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
- National Hospital Organization Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | - Takayoshi Owada
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Hajime Arifuku
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Kenya Koyama
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Hirokuni Hirata
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Yasutsugu Fukushima
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
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D’Agnano V, Mariniello DF, Ruotolo M, Quarcio G, Moriello A, Conte S, Sorrentino A, Sanduzzi Zamparelli S, Bianco A, Perrotta F. Targeting Progression in Pulmonary Fibrosis: An Overview of Underlying Mechanisms, Molecular Biomarkers, and Therapeutic Intervention. Life (Basel) 2024; 14:229. [PMID: 38398739 PMCID: PMC10890660 DOI: 10.3390/life14020229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/22/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
Interstitial lung diseases comprise a heterogenous range of diffuse lung disorders, potentially resulting in pulmonary fibrosis. While idiopathic pulmonary fibrosis has been recognized as the paradigm of a progressive fibrosing interstitial lung disease, other conditions with a progressive fibrosing phenotype characterized by a significant deterioration of the lung function may lead to a burden of significant symptoms, a reduced quality of life, and increased mortality, despite treatment. There is now evidence indicating that some common underlying biological mechanisms can be shared among different chronic fibrosing disorders; therefore, different biomarkers for disease-activity monitoring and prognostic assessment are under evaluation. Thus, understanding the common pathways that induce the progression of pulmonary fibrosis, comprehending the diversity of these diseases, and identifying new molecular markers and potential therapeutic targets remain highly crucial assignments. The purpose of this review is to examine the main pathological mechanisms regulating the progression of fibrosis in interstitial lung diseases and to provide an overview of potential biomarker and therapeutic options for patients with progressive pulmonary fibrosis.
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Affiliation(s)
- Vito D’Agnano
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (V.D.); (D.F.M.); (M.R.); (G.Q.); (A.M.); (S.C.); (A.S.); (A.B.)
| | - Domenica Francesca Mariniello
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (V.D.); (D.F.M.); (M.R.); (G.Q.); (A.M.); (S.C.); (A.S.); (A.B.)
| | - Michela Ruotolo
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (V.D.); (D.F.M.); (M.R.); (G.Q.); (A.M.); (S.C.); (A.S.); (A.B.)
| | - Gianluca Quarcio
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (V.D.); (D.F.M.); (M.R.); (G.Q.); (A.M.); (S.C.); (A.S.); (A.B.)
| | - Alessandro Moriello
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (V.D.); (D.F.M.); (M.R.); (G.Q.); (A.M.); (S.C.); (A.S.); (A.B.)
| | - Stefano Conte
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (V.D.); (D.F.M.); (M.R.); (G.Q.); (A.M.); (S.C.); (A.S.); (A.B.)
| | - Antonio Sorrentino
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (V.D.); (D.F.M.); (M.R.); (G.Q.); (A.M.); (S.C.); (A.S.); (A.B.)
| | | | - Andrea Bianco
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (V.D.); (D.F.M.); (M.R.); (G.Q.); (A.M.); (S.C.); (A.S.); (A.B.)
| | - Fabio Perrotta
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy; (V.D.); (D.F.M.); (M.R.); (G.Q.); (A.M.); (S.C.); (A.S.); (A.B.)
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Tsujii A, Isoda K, Yoshimura M, Nakabayashi A, Kim DS, Tamada T, Yamamoto K, Ohshima S. Janus kinase inhibitors vs. abatacept about safety and efficacy for patients with rheumatoid arthritis-associated interstitial lung disease: a retrospective nested case-control study. BMC Rheumatol 2024; 8:4. [PMID: 38273359 PMCID: PMC10811846 DOI: 10.1186/s41927-024-00374-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Interstitial lung disease (ILD) related to rheumatoid arthritis (RA) is among the leading causes of death and an essential prognostic factor. There is only limited evidence for the safety of anti-rheumatic drugs for patients with RA-ILD. The aim of this study is to investigate the safety and efficacy of Janus kinase inhibitors (JAKis) by comparing it with abatacept (ABT) in patients with RA-ILD. METHODS This single centre, retrospective nested case-control study enrolled patients with RA-ILD treated with JAKi or ABT. To determine the safety of the two drugs for existing ILD, we compared their drug persistency, incidence rates of pulmonary complications, and change of chest computed tomography (CT) image. For their efficacy as RA treatment, disease activity scores and prednisolone (PSL)-sparing effect were compared. We performed propensity score matching to match the groups' patient characteristics. RESULTS We studied 71 patients with RA-ILD (ABT, n = 45; JAKi, n = 26). At baseline, the JAKi group had longer disease duration, longer duration of past bDMARD or JAKi use and higher usual interstitial pneumonia rate. After propensity score matching, no significant differences in patient characteristics were found between the two groups. No significant difference in the drug persistency rate for the first 2 years (ABT, 61.9%; JAKi, 42.8%; P = 0.256) was observed between the two matched groups. The incidence rate of pulmonary complications did not differ significantly between the two groups (P = 0.683). The CT score did not change after the treatment for the ABT group (Ground-glass opacities (GGO): P = 0.87; fibrosis: P = 0.78), while the GGO score significantly improved for the JAKi group (P = 0.03), although the number was limited (ABT: n = 7; JAKi: n = 8). The fibrosis score of the JAKi group did not change significantly.(P = 0.82). Regarding the efficacy for RA, a significant decrease in disease activity scores after the 1-year treatment was observed in both groups, and PSL dose was successfully tapered, although no significant differences were observed between the two drugs. CONCLUSIONS JAKi is as safe and effective as ABT for patients with RA-ILD. JAKi can be a good treatment option for such patients.
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Affiliation(s)
- Atsuko Tsujii
- Department of Rheumatology, NHO Osaka Minami Medical Centre, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
| | - Kentaro Isoda
- Department of Clinical Research/Rheumatology, NHO Osaka Minami Medical Centre, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
| | - Maiko Yoshimura
- Department of Rheumatology, NHO Osaka Minami Medical Centre, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
| | - Akihiko Nakabayashi
- Department of Rheumatology, NHO Osaka Minami Medical Centre, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
| | - Dong-Seop Kim
- Department of Rheumatology, NHO Osaka Minami Medical Centre, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
| | - Tatsuya Tamada
- Department of Rheumatology, NHO Osaka Minami Medical Centre, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
| | - Kurumi Yamamoto
- Department of Rheumatology, NHO Osaka Minami Medical Centre, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan
| | - Shiro Ohshima
- Department of Clinical Research, NHO Osaka Minami Medical Centre, 2-1 Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan.
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Jang JH, Ko J, Jung SY, Kim DW, Oh JH, Kim TJ, Park JH, Choi M, Lee JH. Antifibrotic Agents in Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Systematic Review and Meta-Analysis. Life (Basel) 2023; 13:2318. [PMID: 38137919 PMCID: PMC10744810 DOI: 10.3390/life13122318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a common extra-articular clinical manifestation of rheumatoid arthritis (RA) that has negative impacts on morbidity and mortality. In addition, there has been no proven treatment for RA-ILD to date. Thus, we planned a meta-analysis of a literature search to confirm the clinical effects of antifibrotic agents in RA-ILD patients. MATERIALS AND METHODS We conducted the literature search in Ovid MEDLIVE® databases, Cochrane Library databases, EMBASE, and KoreaMed and identified references elucidating the role of nintedanib or pirfenidone in adult patients with RA-ILD. Among the identified studies, those with comparative interventions, complete results of clinical trials, and available full text were included in the analysis. The primary outcome was the effect of the antifibrotic agent on disease progression in RA-ILD patients assessed with a mean difference in the change of forced vital capacity (FVC) and the proportion of patients with an increase in percent predicted FVC of 10% or more over 52 weeks. Analysis for heterogeneity was assessed through I2 statistics. Meta-analysis with a fixed effect model was performed on changes in FVC. RESULTS A total of 153 articles were identified through database searches, of which 28 were excluded because of duplication. After additional screening, 109 studies were selected with full text and two articles qualified for analysis according to the set inclusion and exclusion criteria. As a result, two randomized controlled studies were selected, comparing nintedanib and pirfenidone to placebo, respectively. The meta-analysis revealed that antifibrotic agents showed a significant reduction in FVC decline compared to placebo in patients with RA-ILD (mean difference, 88.30; 95% CI, 37.10-139.50). Additionally, there were significantly fewer patients experienced an increase in percent predicted FVC of 10% or more in the antifibrotic agent group compared to the placebo group (Odds ratio 0.42; 95% CI 0.19-0.95, p = 0.04). There was no significant heterogeneity between the two included studies (χ2 = 0.35, p = 0.0007, I2 = 0%). CONCLUSIONS The meta-analysis suggests that nintedanib and pirfenidone may have clinical utility in reducing disease progression in patients with RA-ILD. Further research is needed to confirm the clinical benefits of antifibrotic agents in RA-ILD.
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Affiliation(s)
- Ji Hoon Jang
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea;
| | - Junghae Ko
- Division of Endocrinology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea;
| | - So Young Jung
- Department of Dermatology, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea;
| | - Dae-Wook Kim
- Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea;
| | - Ju Hyun Oh
- Department of Pulmonary and Critical Care Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Republic of Korea;
| | - Tae-Jung Kim
- Department of Hospital Pathology, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul 07345, Republic of Korea;
| | - Joo Hun Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea;
| | - Miyoung Choi
- Division of Health Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency (NECA), Seoul 04933, Republic of Korea;
| | - Jae Ha Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea;
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Hecquet S, Combier A, Steelandt A, Pons M, Wendling D, Molto A, Miceli-Richard C, Allanore Y, Avouac J. Characteristics of patients with difficult-to-treat rheumatoid arthritis in a French single-centre hospital. Rheumatology (Oxford) 2023; 62:3866-3874. [PMID: 36961324 DOI: 10.1093/rheumatology/kead143] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/20/2023] [Accepted: 02/27/2023] [Indexed: 03/25/2023] Open
Abstract
OBJECTIVES To compare the features of difficult-to-treat rheumatoid arthritis (D2TRA) patients using two different definitions according to the previous failure of targeted therapies. METHODS We stratified consecutive RA patients treated at Cochin Hospital into two groups, a D2TRA group and a non-D2TRA group, according to two definitions of D2TRA. Both definitions defined D2TRA as RAs failing at least two targeted therapies, with a different mechanism of action for the EULAR-D2TRA definition or without prejudging the mechanism of action and for the Alternative D2TRA definition. RESULTS We included 320 consecutive RA patients. We identified 76 EULAR-D2TRA and 244 non-DTRA patients, and 120 Alternative D2TRA and 200 non-DTRA patients. Compared with non-D2TRA, D2TRA patients from both definitions were more likely to have lower socioeconomic level, positive rheumatoid factor, interstitial lung disease, higher DAS28-CRP and were more likely to respond to rituximab and Janus kinase inhibitors. Although EULAR and Alternative D2TRA patients displayed similar clinical and biological features, they were characterized by different therapeutic profiles. We observed fewer patients receiving methotrexate in the Alternative D2TRA group (53% vs 64%, P = 0.046). Patients with Alternative D2TRA not fulfilling the EULAR definition (n = 44) had all received two successive first-line TNF inhibitors, a monoclonal antibody and a soluble receptor, and were comparable to EULAR-D2TRA patients with regards to all other characteristics. CONCLUSION Low socioeconomic status, diabetes, interstitial lung disease and absence of combination with methotrexate allow identification of D2TRA. In addition, the inclusion as 'early-D2TRA' of patients failing two TNF inhibitors in the EULAR definition of D2TRA would facilitate the rapid identification of D2TRA patients.
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Affiliation(s)
- Sophie Hecquet
- Department of Rheumatology, Cochin Hospital, APHP, Université Paris Cité, Paris, France
- Department of Rheumatology, CHU Besançon, Besançon, France
| | - Alice Combier
- Department of Rheumatology, Cochin Hospital, APHP, Université Paris Cité, Paris, France
| | - Alexia Steelandt
- Department of Rheumatology, Cochin Hospital, APHP, Université Paris Cité, Paris, France
| | - Marion Pons
- Department of Rheumatology, Cochin Hospital, APHP, Université Paris Cité, Paris, France
| | | | - Anna Molto
- Department of Rheumatology, Cochin Hospital, APHP, Université Paris Cité, Paris, France
| | | | - Yannick Allanore
- Department of Rheumatology, Cochin Hospital, APHP, Université Paris Cité, Paris, France
| | - Jérôme Avouac
- Department of Rheumatology, Cochin Hospital, APHP, Université Paris Cité, Paris, France
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Takami K, Tsuji S. Real-world retention rates of biologics in patients with rheumatoid arthritis. Sci Rep 2023; 13:21170. [PMID: 38040839 PMCID: PMC10692158 DOI: 10.1038/s41598-023-48537-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023] Open
Abstract
Although biologics have their own characteristics, there are no clear criteria for selecting them to treat the patients with rheumatoid arthritis. To assist in selecting biologics, we investigated the retention rates of biologics at our institution. We examined retention rates, and reasons for dropout for biologics in 393 cases and 605 prescriptions (of which 378 prescriptions were as naive) at our hospital since October 2003. Throughout the entire course of the study, etanercept (ETN) was the most frequently used biologic, followed by adalimumab (ADA) and tocilizumab (TCZ). When narrowed down to the later period from 2010, ETN was still the most used, followed by TCZ and abatacept (ABT). When the retention rates were compared in biologic naive patients, the retention rates were TCZ, ABT, ETN, certolizumab pegol (CZP), golimumab (GLM), infliximab (IFX), and ADA, in that order. The retention rates were better with the first use of each biologic. The main reasons for dropout were primary ineffectiveness, secondary ineffectiveness, and infection. ETN was the most used biologic in our hospital, with an increasing trend toward the use of non-TNF inhibitors. Retention rates were higher in non-TNF inhibitors.
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Affiliation(s)
- Kenji Takami
- Department of Orthopaedic Surgery, Nippon Life Hospital, 2-1-54 Enokojima, Nishi-ku, Osaka, 550-0006, Japan.
- Department of Rheumatology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan.
| | - Shigeyoshi Tsuji
- Department of Orthopaedic Surgery, Nippon Life Hospital, 2-1-54 Enokojima, Nishi-ku, Osaka, 550-0006, Japan
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9
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Harrington R, Harkins P, Conway R. Targeted Therapy in Rheumatoid-Arthritis-Related Interstitial Lung Disease. J Clin Med 2023; 12:6657. [PMID: 37892795 PMCID: PMC10607625 DOI: 10.3390/jcm12206657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune multisystem inflammatory disease in which lung involvement is the most common extra-articular manifestation. Parenchymal lung involvement or interstitial lung disease (ILD) is a significant cause of morbidity and mortality and there is a paucity of evidence-based guidance on how to best treat RA-ILD. This review article aims to evaluate the evidence from cohort studies and best real word data from registries. Extensive discussion of the relative merits and drawbacks of glucocorticoids, various biologics, small molecules and anti-fibrotics is presented. The limited available guidelines in RA-ILD are also discussed and a rational treatment algorithm is offered.
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10
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Woo S, Gandhi S, Ghincea A, Saber T, Lee CJ, Ryu C. Targeting the NLRP3 inflammasome and associated cytokines in scleroderma associated interstitial lung disease. Front Cell Dev Biol 2023; 11:1254904. [PMID: 37849737 PMCID: PMC10577231 DOI: 10.3389/fcell.2023.1254904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/19/2023] [Indexed: 10/19/2023] Open
Abstract
SSc-ILD (scleroderma associated interstitial lung disease) is a complex rheumatic disease characterized in part by immune dysregulation leading to the progressive fibrotic replacement of normal lung architecture. Because improved treatment options are sorely needed, additional study of the fibroproliferative mechanisms mediating this disease has the potential to accelerate development of novel therapies. The contribution of innate immunity is an emerging area of investigation in SSc-ILD as recent work has demonstrated the mechanistic and clinical significance of the NLRP3 inflammasome and its associated cytokines of TNFα (tumor necrosis factor alpha), IL-1β (interleukin-1 beta), and IL-18 in this disease. In this review, we will highlight novel pathophysiologic insights afforded by these studies and the potential of leveraging this complex biology for clinical benefit.
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Affiliation(s)
| | | | | | | | | | - Changwan Ryu
- Department of Internal Medicine, Yale School of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, New Haven, CT, United States
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Andronache IT, Şuţa VC, Şuţa M, Ciocodei SL, Vladareanu L, Nicoara AD, Arghir OC. Better Safe than Sorry: Rheumatoid Arthritis, Interstitial Lung Disease, and Medication-A Narrative Review. Biomedicines 2023; 11:1755. [PMID: 37371850 DOI: 10.3390/biomedicines11061755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
It is well known that rheumatoid arthritis (RA) patients are at an increased risk of developing non-infectious pulmonary complications, especially interstitial lung disease (ILD); however, the clinician must keep in mind that lung disease could not only be a manifestation of the underlying condition, but also a consequence of using disease-modifying therapies. New-onset ILD or ILD worsening has also been reported as a possible consequence of both conventional disease-modifying antirheumatic drugs (DMARDs) and biologic agents. This study is a narrative review of the current literature regarding the potential risk of developing interstitial lung disease along with the administration of specific drugs used in controlling rheumatoid arthritis. Its purpose is to fill knowledge gaps related to this challenging patient cohort by addressing various aspects of the disease, including prevalence, disease features, treatment strategies, and patient outcomes.
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Affiliation(s)
- Iulia-Tania Andronache
- Doctoral School of Medicine, "Ovidius" University of Constanta, 900470 Constanta, Romania
- Department of Rheumatology, Internal Medicine Clinic, "Dr. Alexandru Gafencu" Military Emergency Hospital Constanta, 900527 Constanta, Romania
| | - Victoria-Cristina Şuţa
- 3rd Department-1st Clinical Medical Disciplines, Faculty of Medicine, "Ovidius" University of Constanta, 900470 Constanta, Romania
| | - Maria Şuţa
- Doctoral School of Medicine, "Ovidius" University of Constanta, 900470 Constanta, Romania
| | - Sabina-Livia Ciocodei
- Doctoral School of Medicine, "Ovidius" University of Constanta, 900470 Constanta, Romania
| | - Liliana Vladareanu
- Doctoral School of Medicine, "Ovidius" University of Constanta, 900470 Constanta, Romania
| | - Alina Doina Nicoara
- 3rd Department-1st Clinical Medical Disciplines, Faculty of Medicine, "Ovidius" University of Constanta, 900470 Constanta, Romania
| | - Oana Cristina Arghir
- Doctoral School of Medicine, "Ovidius" University of Constanta, 900470 Constanta, Romania
- 4th Department-2nd Clinical Medical Disciplines, Faculty of Medicine, "Ovidius" University of Constanta, 900470 Constanta, Romania
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Lopetuso LR, Cuomo C, Mignini I, Gasbarrini A, Papa A. Focus on Anti-Tumour Necrosis Factor (TNF)-α-Related Autoimmune Diseases. Int J Mol Sci 2023; 24:ijms24098187. [PMID: 37175894 PMCID: PMC10179362 DOI: 10.3390/ijms24098187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
Anti-tumour necrosis factor (TNF)-α agents have been increasingly used to treat patients affected by inflammatory bowel disease and dermatological and rheumatologic inflammatory disorders. However, the widening use of biologics is related to a new class of adverse events called paradoxical reactions. Its pathogenesis remains unclear, but it is suggested that cytokine remodulation in predisposed individuals can lead to the inflammatory process. Here, we dissect the clinical aspects and overall outcomes of autoimmune diseases caused by anti-TNF-α therapies.
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Affiliation(s)
- Loris Riccardo Lopetuso
- Center for Diagnosis and Treatment of Digestive Diseases, CEMAD, Gastroenterology Department, Fondazione Policlinico Gemelli, IRCCS, 00168 Rome, Italy
- Department of Medicine and Ageing Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
- Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Claudia Cuomo
- Center for Diagnosis and Treatment of Digestive Diseases, CEMAD, Gastroenterology Department, Fondazione Policlinico Gemelli, IRCCS, 00168 Rome, Italy
| | - Irene Mignini
- Center for Diagnosis and Treatment of Digestive Diseases, CEMAD, Gastroenterology Department, Fondazione Policlinico Gemelli, IRCCS, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Center for Diagnosis and Treatment of Digestive Diseases, CEMAD, Gastroenterology Department, Fondazione Policlinico Gemelli, IRCCS, 00168 Rome, Italy
- Department of Translational Medicine and Surgery, School of Medicine, Catholic University, 00168 Rome, Italy
| | - Alfredo Papa
- Center for Diagnosis and Treatment of Digestive Diseases, CEMAD, Gastroenterology Department, Fondazione Policlinico Gemelli, IRCCS, 00168 Rome, Italy
- Department of Translational Medicine and Surgery, School of Medicine, Catholic University, 00168 Rome, Italy
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Matson SM, Demoruelle MK. Connective Tissue Disease Associated Interstitial Lung Disease. Immunol Allergy Clin North Am 2023; 43:229-244. [PMID: 37055086 DOI: 10.1016/j.iac.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Connective tissue disease associated interstitial lung disease (CTD-ILD) is a heterogenous collection of conditions with a diverse spectrum of interstitial lung disease (ILD) manifestations. Currently, clinical practice of lung-directed immunosuppression in CTD-ILD is supported by several randomized, placebo-controlled trials (RCTs) in patients with scleroderma and several observational, retrospective studies in other autoimmune conditions. However, given the harm of immunosuppression in idiopathic pulmonary fibrosis, there is an urgent need for RCTs of immunosuppression and antifibrotic agents in fibrotic CTD-ILD populations as well as the study of intervention in patients with subclinical CTD-ILD.
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Affiliation(s)
- Scott M Matson
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas School of Medicine, 3901 Rainbow boulevard, Mailstop 3007, Kansas City, KS 66160, USA
| | - M Kristen Demoruelle
- Division of Rheumatology, University of Colorado School of Medicine, 1775 Aurora Court, Mail Stop B-115, Aurora, CO 80045, USA.
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Mochizuki T, Yano K, Ikari K, Okazaki K. Radiological evaluation of interstitial lung disease in patients with rheumatoid arthritis treated with abatacept or JAK inhibitors for 1 year. Respir Investig 2023; 61:359-363. [PMID: 37031622 DOI: 10.1016/j.resinv.2023.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/09/2023] [Accepted: 02/14/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND We evaluated the radiological deterioration of interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA) treated with abatacept (ABT) or Janus-kinase inhibitors (JAKi) for 1 year. METHODS This study enrolled 84 patients with RA who had started treatment with ABT (48 patients) or JAKi (36 patients) between 2017 and 2020. All patients underwent chest CT before administration and at 1 year post-treatment. RESULTS In all patients, the rate of deterioration of ILD in ABT and JAKi was 4.2% and 5.6%, respectively (p = 0.847). In the patients with pre-existing ILD, the rates of deterioration of ILD in the ABT and JAKi groups were 10.5% and 18.2%, respectively (p = 0.611). Meanwhile, newly developed ILD did not occur in the two groups without pre-existing ILD. CONCLUSION The present study demonstrated that the safety of pulmonary toxicity with ABT and JAKi treatments was similar in patients with RA. JAKi may be a potentially acceptable treatment option for patients with RA.
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Affiliation(s)
- Takeshi Mochizuki
- Department of Orthopaedic Surgery and Rheumatology, Kamagaya General Hospital, 929-6 Hatsutomi, Kamagaya, 273-0121, Chiba, Japan.
| | - Koichiro Yano
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada, Shinjyuku, 162-8666, Tokyo, Japan
| | - Katsunori Ikari
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada, Shinjyuku, 162-8666, Tokyo, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada, Shinjyuku, 162-8666, Tokyo, Japan
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Koulouri V, Bakasis AD, Marketos N, Tavernaraki K, Giannelou M, Moutsopoulos HM, Mavragani CP. Scleroderma specific autoantibodies in rheumatoid arthritis and Sjögren's syndrome patients with interstitial lung disease: Prevalence and associations. J Transl Autoimmun 2022; 6:100183. [PMID: 36619654 PMCID: PMC9816776 DOI: 10.1016/j.jtauto.2022.100183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Systemic sclerosis (SSc) has been classically linked to interstitial lung disease (ILD) development, often in association with specific SSc autoantibodies. In the present report, we aimed to estimate the prevalence of SSc autoantibodies in 60 seropositive RA and 41 primary SS patients complicated or not by ILD. SSc autoantibodies were determined in patients' sera by a commercial immunoblot assay. RA ILD patients displayed higher frequency of SSc-specific antibodies at strong titers compared to RA-with no lung involvement (25% vs 3.1%, p = 0.01)[OR 95% CI:10.9 (1.2-94.5)], with no differences detected between primary SS groups. These data indicate that many seropositive RA ILD patients probably represent an overlap RA/SSc entity, requiring tailored diagnostic and therapeutic approach.
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Affiliation(s)
- Vasiliki Koulouri
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Greece,Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | | | - Nikolaos Marketos
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Kyriaki Tavernaraki
- Imaging and Interventional Radiology, Sotiria General and Chest Diseases Hospital, Athens, Greece
| | - Mayra Giannelou
- Department of Rheumatology, General Hospital of Athens “G. Gennimatas”, Greece
| | | | - Clio P. Mavragani
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Greece,Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Athens, Greece,Corresponding author. Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, M.Asias 75, 11527, Athens, Greece
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Assioura A, Gkrepi G, Exarchos K, Kostikas K, Gogali A, Kyriakopoulos C. Recurrent bilateral lung infiltrates in a patient with ulcerative colitis. Breathe (Sheff) 2022; 18:220210. [PMID: 36865931 PMCID: PMC9973526 DOI: 10.1183/20734735.0210-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/15/2022] [Indexed: 01/12/2023] Open
Abstract
In all cases of ILD in patients with UC, drug-induced pneumonitis should be excluded. In patients who receive both anti-TNF-α and mesalazine and develop drug-induced pneumonitis, it is quite difficult to differentiate which is the actual causing agent. https://bit.ly/3AnNJNN.
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Affiliation(s)
- Antonia Assioura
- Respiratory Medicine Department, University of Ioannina Faculty of Medicine, Ioannina, Greece
| | - Georgia Gkrepi
- Respiratory Medicine Department, University of Ioannina Faculty of Medicine, Ioannina, Greece
| | - Konstantinos Exarchos
- Respiratory Medicine Department, University of Ioannina Faculty of Medicine, Ioannina, Greece
| | - Konstantinos Kostikas
- Respiratory Medicine Department, University of Ioannina Faculty of Medicine, Ioannina, Greece
| | - Athena Gogali
- Respiratory Medicine Department, University of Ioannina Faculty of Medicine, Ioannina, Greece
| | - Christos Kyriakopoulos
- Respiratory Medicine Department, University of Ioannina Faculty of Medicine, Ioannina, Greece,Corresponding author: Christos Kyriakopoulos ()
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Narváez J, Díaz Del Campo Fontecha P, Brito García N, Bonilla G, Aburto M, Castellví I, Cano-Jiménez E, Mena-Vázquez N, Nieto MA, Ortiz AM, Valenzuela C, Abad Hernández MÁ, Castrejón I, Correyero Plaza M, Francisco Hernández FM, Hernández Hernández MV, Rodríquez Portal JA. SER-SEPAR recommendations for the management of rheumatoid arthritis-related interstitial lung disease. Part 2: Treatment. REUMATOLOGIA CLINICA 2022; 18:501-512. [PMID: 36064885 DOI: 10.1016/j.reumae.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To develop multidisciplinary recommendations to improve the management of rheumatoid arthritis-related interstitial lung disease (RA-ILD). METHODS Clinical research questions relevant to the objective of the document were identified by a panel of rheumatologists and pneumologists selected based on their experience in the field. Systematic reviews of the available evidence were conducted, and evidence was graded according to the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Specific recommendations were made. RESULTS Six PICO questions were selected, three of which analysed the safety and effectiveness of glucocorticoids, classical synthetic disease-modifying anti-rheumatic drugs (DMARDs) and other immunosuppressants, biological agents, targeted synthetic DMARDs, and antifibrotic therapies in the treatment of this complication. A total of 12 recommendations were formulated based on the evidence found and/or expert consensus. CONCLUSIONS We present the first official SER-SEPAR document with specific recommendations for RA-ILD management developed to resolve some common clinical questions, reduce clinical healthcare variability, and facilitate decision-making for patients.
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Affiliation(s)
- Javier Narváez
- Servicio de Reumatología, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
| | | | - Noé Brito García
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain
| | - Gema Bonilla
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, Spain
| | - Myriam Aburto
- Servicio de Neumología, Hospital Universitario Galdakao-Usansolo, Bilbao, Spain
| | - Iván Castellví
- Servicio de Reumatología, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Natalia Mena-Vázquez
- Servicio de Reumatología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - M Asunción Nieto
- Servicio de Neumología, Hospital Clínico San Carlos, Madrid, Spain
| | - Ana María Ortiz
- Servicio de Reumatología, Hospital Universitario de La Princesa, Madrid, Spain
| | - Claudia Valenzuela
- Servicio de Neumología, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Isabel Castrejón
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Correyero Plaza
- Servicio de Reumatología, Hospital Universitario Quironsalud de Pozuelo, Pozuelo de Alarcón, Madrid, Spain
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Diesler R, Cottin V. Pulmonary fibrosis associated with rheumatoid arthritis: from pathophysiology to treatment strategies. Expert Rev Respir Med 2022; 16:541-553. [PMID: 35695895 DOI: 10.1080/17476348.2022.2089116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is the most common inflammatory autoimmune disease, characterised by symmetric destructive arthritis and synovitis. Lung involvement is frequent, including in the form of interstitial lung disease (ILD). RA-ILD often presents with a radiologic and pathologic pattern of usual interstitial pneumonia, similar to idiopathic pulmonary fibrosis, highlighting the similarities between the two diseases, but other patterns and pathological associations are described. AREAS COVERED This article reviews the pathogenesis of pulmonary fibrosis in the setting of rheumatoid arthritis as well as the current and future therapeutic options. EXPERT OPINION Pulmonary fibrosis in the setting of RA-ILD is an example of genotype-environment interaction and involves multiple mechanisms including autoimmunity, inflammation and fibrogenesis. Despite that ILD conveys most of the exceeding mortality in RA patients, there are no official guidelines for the management of RA-ILD. Attention should be paid to potential lung toxicity of RA treatment even though some of them might help stabilise the ILD. Current standard of care is often composed of glucocorticoids that may be associated with immunosuppressive therapy. Following the approval of antifibrotic therapy for ILDs with a progressive fibrosing phenotype, current works are evaluating the benefit of such treatment in RA-ILD.
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Affiliation(s)
- Rémi Diesler
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, University of Lyon, INRAE, Lyon, France
| | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, University of Lyon, INRAE, Lyon, France
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Otsuka J, Yoshizawa S, Kudo K, Osoreda H, Ishimatsu A, Taguchi K, Moriwaki A, Wakamatsu K, Iwanaga T, Yoshida M. Clinical features of acute exacerbation in rheumatoid arthritis–associated interstitial lung disease: Comparison with idiopathic pulmonary fibrosis. Respir Med 2022; 200:106898. [DOI: 10.1016/j.rmed.2022.106898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/17/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
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Laria A, Lurati AM, Zizzo G, Zaccara E, Mazzocchi D, Re KA, Marrazza M, Faggioli P, Mazzone A. Interstitial Lung Disease in Rheumatoid Arthritis: A Practical Review. Front Med (Lausanne) 2022; 9:837133. [PMID: 35646974 PMCID: PMC9136053 DOI: 10.3389/fmed.2022.837133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory disease, which primarily causes symmetric polyarthritis. An extrarticolar involvement is common, and the commonly involved organ is lungs. Although cardiac disease is responsible for most RA-related deaths, pulmonary disease is also a major contributor, accounting for ~10-20% of all mortality. Pulmonary disease is a common (60-80% of patients with RA) extra-articular complication of RA. Optimal screening, diagnostic, and treatment strategies of pulmonary disease remain uncertain, which have been the focus of an ongoing investigation. Clinicians should regularly assess patients with RA for the signs and symptoms of pulmonary disease and, reciprocally, consider RA and other connective tissue diseases when evaluating a patient with pulmonary disease of an unknown etiology. RA directly affects all anatomic compartments of the thorax, including the lung parenchyma, large and small airways, pleura, and less commonly vessels. In addition, pulmonary infection and drug-induced lung disease associated with immunosuppressive agents used for the treatment of RA may occur.
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Affiliation(s)
- Antonella Laria
- Asst Ovest Milanese–Rheumatology Unit, Magenta Hospital, Milan, Italy
| | | | - Gaetano Zizzo
- Asst Ovest Milanese–Internal Medicine Department, Cuggiono Hospital, Milan, Italy
| | - Eleonora Zaccara
- Asst Ovest Milanese–Internal Medicine Unit, Legnano Hospital, Milan, Italy
| | - Daniela Mazzocchi
- Asst Ovest Milanese–Rheumatology Unit, Magenta Hospital, Milan, Italy
| | - Katia Angela Re
- Asst Ovest Milanese–Rheumatology Unit, Magenta Hospital, Milan, Italy
| | | | - Paola Faggioli
- Asst Ovest Milanese–Internal Medicine Unit, Legnano Hospital, Milan, Italy
| | - Antonino Mazzone
- Asst Ovest Milanese–Internal Medicine Unit, Legnano Hospital, Milan, Italy
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Conway R, Nikiphorou E. Efficacy and safety of conventional synthetic, biologic and targeted synthetic DMARDs in RA-ILD: A narrative review. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_157_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mori Y, Izumiyama T, Mori N, Aizawa T. Interstitial Lung Disease in a Woman with Rheumatoid Arthritis Treated with Denosumab: A Case Report. Mod Rheumatol Case Rep 2021; 6:155-159. [PMID: 34791403 DOI: 10.1093/mrcr/rxab046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/30/2021] [Accepted: 10/21/2021] [Indexed: 11/12/2022]
Abstract
The present report describes the case of an 84-year-old female Japanese patient with rheumatoid arthritis (RA) who experienced exacerbation of interstitial lung disease (ILD) after denosumab (Dmab) treatment. The onset of RA occurred in 2008, and the patient had been treated with intravenous or subcutaneous injection of tocilizumab (TCZ) since 2009. In July 2013, she experienced a lumbar vertebral fracture and began treatment with 60-mg Dmab injection every 6 months in January 2014. The patient had a history of mild ILD and was evaluated for ILD by chest computed tomography (CT) imaging prior to the start of Dmab use. The vertebral fracture did not recur after the initiation of Dmab treatment, and her osteoporosis was successfully treated. However, she expressed a concern of exacerbations of cough and respiratory discomfort that had occurred since September 2019. The chest CT image in November 2015 showed minor ILD progression, whereas the image in September 2019 showed severe exacerbation of ILD. To treat this exacerbation, 10 mg of methylprednisolone (mPSL) and 2.5 mg of tacrolimus (TAC) were administered, and Dmab was discontinued. The patient was subsequently switched to oral bisphosphonate. The patient's respiratory discomfort and the finding of interstitial lung lesion in CT imaging improved after Dmab discontinuation. This case showed that exacerbation of ILD may occur after Dmab treatment, and physicians should consider the risks of Dmab-related ILD in patients with RA complicated by ILD.
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Affiliation(s)
- Yu Mori
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takuya Izumiyama
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Naoko Mori
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Toshimi Aizawa
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Carrasco Cubero C, Chamizo Carmona E, Vela Casasempere P. Systematic review of the impact of drugs on diffuse interstitial lung disease associated with rheumatoid arthritis. ACTA ACUST UNITED AC 2021; 17:504-513. [PMID: 34756311 DOI: 10.1016/j.reumae.2020.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/22/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To review the available evidence on the impact of rheumatoid arthritis (RA) treatments in associated diffuse interstitial lung disease (ILD). METHODS Systematic review of studies evaluating the impact of pharmacological treatment in patients with RA and ILD. A bibliographic search in MEDLINE, EMBASE and Cochrane, a selection of articles and the methodological quality assessment (FLC 3.0 OSTEBA) and grading of the level of evidence (SING) of the selected articles were performed. RESULTS 1,720 references were identified in primary search and 7 in manual or indirect. Forty-three articles were included: 7 systematic reviews, 2 randomized clinical trials, 5 cohort studies, 8 case-control studies and 21 case series. Methotrexate (MTX) and leflunomide (LEF) do not increase incidence, complications or mortality due to ILD. Although the results are not uniform, anti-TNF have often had worse outcomes in incidence, progression and mortality due to ILD than MTX, LEF, abatacept (ABA) and rituximab (RTX). The evidence found is scarce for JAK kinase and antifibrotic inhibitors, and controversial for IL-6 inhibitors. CONCLUSIONS There is no evidence that MTX or LEF worsens the prognosis of patients with AR-EPID. RTX and ABA seem to have better results than other biologicals, such us TNFi, often achieving stabilization and, in some cases, the improvement of ILD in patients with RA.
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Xu L, Jiang L, Nie L, Zhang S, Liu L, Du Y, Xue J. Soluble programmed death molecule 1 (sPD-1) as a predictor of interstitial lung disease in rheumatoid arthritis. BMC Immunol 2021; 22:69. [PMID: 34654367 PMCID: PMC8518160 DOI: 10.1186/s12865-021-00460-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/30/2021] [Indexed: 01/23/2023] Open
Abstract
Background Previous studies have indicated that the programmed death molecule 1 (PD-1) signaling pathway may play a key role in rheumatoid arthritis (RA). However, the pathogenesis of rheumatoid arthritis-related interstitial lung disease (RA-ILD) is not clear. We examined the serum levels of soluble PD-1 in patients with RA and its relationship with RA-ILD.
Methods Blood samples were obtained from 87 patients with RA (58 with ILD and 29 without ILD) and 45 healthy controls. Serum sPD-1 was measured by Enzyme-Linked Immunosorbent Assay. The pulmonary interstitial disease score was completed by a pulmonary physician and a radiologist through chest high-resolution computed tomography. Patients with RA-ILD were tested for lung function [e.g., forced vital capacity (FVC%), diffusing capacity of lungs for carbon monoxide (DLCO%)]. Associations between ILD and various markers, including sPD-1 and confounding factors, were investigated by logistic regression analysis. Diagnostic values of sPD-1 for the presence of ILD were investigated using receiver operating characteristic curve analysis. Results Serum sPD-1 levels were higher in RA patients with ILD than in RA patients without ILD and healthy controls (185.1 ± 109.0 pg/ml vs. 119.1 ± 77.5 pg/ml vs. 52.1 ± 21.7 pg/ml, P < 0.05). Serum sPD-1 levels were positively correlated with RF titer (P = 0.02, r = 0.249), anti-cyclic citrullinated peptide antibody status (P = 0.02, r = 0.243), and serum IgG levels (P < 0.001, r = 0.368), negatively associated with FVC% (P = 0.02, r = − 0.344), forced expiratory volume (FEV1%) (P = 0.01, r = − 0.354), total lung capacity (TLC%) (P = 0.046, r = − 0.302), and was independently associated with the presence of ILD in RA patients by multivariate logistic regression analysis. The sensitivity and specificity of sPD-1 levels for the detection of ILD in RA patients were 58.6% and 75.9%, respectively. The area under the curve was 0.689. Conclusion Serum sPD-1 levels were increased in RA patients with ILD. Increased sPD-1 may be a valuable biomarker to predict the presence of ILD in patients with RA. Supplementary Information The online version contains supplementary material available at 10.1186/s12865-021-00460-6.
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Affiliation(s)
- Li Xu
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.,Department of Medical, Jiaxing University Affiliated Women and Children Hospital (Jiaxing Maternity and Child Health Care Hospital), Jiaxing, 314000, China
| | - Lichun Jiang
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.,Department of Rheumatology, Jiaxing First Hospital, Jiaxing, 314000, China
| | - Liuyan Nie
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Songzhao Zhang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Lei Liu
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yan Du
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
| | - Jing Xue
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
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25
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Sato S, Matsumoto H, Temmoku J, Fujita Y, Matsuoka N, Yashiro-Furuya M, Asano T, Suzuki E, Watanabe H, Kanno T, Migita K. Sustained Long-Term Retention Rates of Abatacept in Combination with Conventional Synthetic Disease-Modifying Antirheumatic Drugs in Elderly Patients with Rheumatoid Arthritis. Medicina (B Aires) 2021; 57:medicina57090914. [PMID: 34577837 PMCID: PMC8469009 DOI: 10.3390/medicina57090914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Treatment for elderly (aged ≥75 years) patients with rheumatoid arthritis (RA) is important because they usually have several complications and organ dysfunction and are more susceptible to drug-related adverse events. Abatacept (ABT) treatment is relatively safe in elderly RA patients; however, the real-world data of efficacy and long-term retention of ABT is sparse in such patients. This study aimed to investigate the clinical efficacy and long-term retention rates of ABT in elderly Japanese RA patients. Materials and Methods: This 10-year retrospective observational cohort study was performed in two centers in Fukushima, Japan. We reviewed the clinical features of elderly RA patients who received ABT and investigated the differences in retention rates with concomitant administration of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Results: The clinical characteristics of younger (<75 years old, 39 cases) and elderly (≥75 years old, 20 cases) RA patients were generally similar. Although the efficacy was also similar, the concomitant administration of csDMARDs with ABT differed between the two groups. Younger patients significantly decreased methotrexate (MTX) administration than elderly patients (p < 0.01), and elderly patients significantly received tacrolimus (TAC) (p < 0.01) or salazosulfapyridine (SASP; p = 0.01) than younger patients. The overall retention and infection-free survival rates were similar between the two groups. Conclusion: Elderly RA patients showed sustained retention rates compared to younger RA patients. TAC and SASP can help to maintain sustained retention rates in elderly RA patients.
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Affiliation(s)
- Shuzo Sato
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Fukushima, Japan; (H.M.); (J.T.); (Y.F.); (N.M.); (M.Y.-F.); (T.A.); (H.W.); (K.M.)
- Correspondence: ; Tel.: +81-24-547-1171; Fax: +81-24-547-1172
| | - Haruki Matsumoto
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Fukushima, Japan; (H.M.); (J.T.); (Y.F.); (N.M.); (M.Y.-F.); (T.A.); (H.W.); (K.M.)
| | - Jumpei Temmoku
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Fukushima, Japan; (H.M.); (J.T.); (Y.F.); (N.M.); (M.Y.-F.); (T.A.); (H.W.); (K.M.)
| | - Yuya Fujita
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Fukushima, Japan; (H.M.); (J.T.); (Y.F.); (N.M.); (M.Y.-F.); (T.A.); (H.W.); (K.M.)
| | - Naoki Matsuoka
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Fukushima, Japan; (H.M.); (J.T.); (Y.F.); (N.M.); (M.Y.-F.); (T.A.); (H.W.); (K.M.)
| | - Makiko Yashiro-Furuya
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Fukushima, Japan; (H.M.); (J.T.); (Y.F.); (N.M.); (M.Y.-F.); (T.A.); (H.W.); (K.M.)
| | - Tomoyuki Asano
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Fukushima, Japan; (H.M.); (J.T.); (Y.F.); (N.M.); (M.Y.-F.); (T.A.); (H.W.); (K.M.)
| | - Eiji Suzuki
- Department of Rheumatology, Ohta Nishinouchi Hospital, Koriyama 963-8558, Fukushima, Japan; (E.S.); (T.K.)
| | - Hiroshi Watanabe
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Fukushima, Japan; (H.M.); (J.T.); (Y.F.); (N.M.); (M.Y.-F.); (T.A.); (H.W.); (K.M.)
| | - Takashi Kanno
- Department of Rheumatology, Ohta Nishinouchi Hospital, Koriyama 963-8558, Fukushima, Japan; (E.S.); (T.K.)
| | - Kiyoshi Migita
- Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Fukushima, Japan; (H.M.); (J.T.); (Y.F.); (N.M.); (M.Y.-F.); (T.A.); (H.W.); (K.M.)
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26
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Sellam J, Morel J, Tournadre A, Bouhnik Y, Cornec D, Devauchelle-Pensec V, Dieudé P, Goupille P, Jullien D, Kluger N, Lazaro E, Le Goff B, de Lédinghen V, Lequerré T, Nocturne G, Seror R, Truchetet ME, Verhoeven F, Pham T, Richez C. PRACTICAL MANAGEMENT of patients on anti-TNF therapy: Practical guidelines drawn up by the Club Rhumatismes et Inflammation (CRI). Joint Bone Spine 2021; 88:105174. [PMID: 33992225 DOI: 10.1016/j.jbspin.2021.105174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jérémie Sellam
- Service de Rhumatologie, CHU Saint-Antoine, Paris, France
| | - Jacques Morel
- Service de Rhumatologie, CHU Montpellier, Montpellier, France
| | - Anne Tournadre
- Service de Rhumatologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Yoram Bouhnik
- Service de Gastro-entérologie, CHU Hôpital Beaujon, Clichy, France
| | - Divi Cornec
- Service de Rhumatologie, CHRU La Cavale Blanche, Brest, France
| | | | - Philippe Dieudé
- Service de Rhumatologie, CHU Bichat-Claude Bernard, Paris, France
| | | | | | - Nicolas Kluger
- Dpt Dermatology, Helsinki, Finland; Service de Dermatologie, CHU Bichat-Claude Bernard, Paris, France
| | - Estibaliz Lazaro
- Service de Médecine interne, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | | | - Victor de Lédinghen
- Unité d'Hépatologie et transplantation hépatique, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | | | | | - Raphaèle Seror
- Service de Rhumatologie, Bicêtre, Le Kremlin-Bicêtre, France
| | | | | | - Thao Pham
- Service de Rhumatologie, CHU Sainte-Marguerite, Marseille, France
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27
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Abatacept in rheumatoid arthritis-associated interstitial lung disease: short-term outcomes and predictors of progression. Clin Rheumatol 2021; 40:4861-4867. [PMID: 34313866 PMCID: PMC8599404 DOI: 10.1007/s10067-021-05854-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Interstitial lung disease in rheumatoid arthritis (RA-ILD) is an extra-articular involvement that impairs the prognosis and for which there is still no well-coded treatment. The aim of this study was to evaluate abatacept (ABA) effectiveness and safety in patients with RA-ILD. METHODS RA-ILD patients who started ABA treatment were consecutively enrolled. Chest high-resolution computed tomography (HRCT), clinical, laboratory and respiratory function variables were collected at baseline and after 18 months of ABA treatment. HRCT abnormalities were evaluated using a computer-aided method (CaM). ABA response was established based on the change in the percentage of fibrosis evaluated at HRCT-CaM, dividing patients into "worsened" (progression ≥ 15%), "improved" (reduction ≥ 15%), and "stable" (changes within the 15% range). The multivariate regression model was used to assess the associations between RA characteristics and ABA response. RESULTS Forty-four patients (81% women, mean age 59.1 ± 8.0, mean disease duration of 7.5 ± 3.1 years) were studied. Five patients (11.4%) showed RA-ILD progression, 32 patients (72.6%) were considered stable, and 7 patients (16.0%) showed an RA-ILD improvement. The proportion of current smokers was significantly different between "worsened" patients, respect to those defined as "improved/stable" (p = 0.01). Current smoking habit (p = 0.005) and concomitant methotrexate treatment (p = 0.0078) were the two variables related to RA-ILD progression in multivariate regression analysis. CONCLUSION Treatment with ABA is associated with a RA-ILD stability or improvement in the 88.6% of patients. Current smoking habit and concomitant treatment with methotrexate are the modifiable factors associated with RA-ILD worsening. Key Points • Abatacept plays a favourable role in the control of RA-ILD, with a significant worsening in only 11.4% of patients during a 18-month follow-up period. • The predictive variables related to RA-ILD progression during abatacept therapy are the concomitant treatment with methotrexate and current smoking habit.
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28
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Kelly CA, Nisar M, Arthanari S, Carty S, Woodhead FA, Price-Forbes A, Middleton D, Dempsey O, Miller D, Basu N, Dawson J, Sathi N, Ahmad Y, Palmer E, Iqbal K, Janakiraman G, Koduri G, Young A. Rheumatoid arthritis related interstitial lung disease - improving outcomes over 25 years: a large multicentre UK study. Rheumatology (Oxford) 2021; 60:1882-1890. [PMID: 33150434 DOI: 10.1093/rheumatology/keaa577] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/14/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study explores whether the prognosis of interstitial lung disease in rheumatoid arthritis (RA-ILD) has improved over time and assesses the potential influence of drug therapy in a large multicentre UK network. METHODS We analysed data from 18 UK centres on patients meeting criteria for both RA and ILD diagnosed over a 25-year period. Data included age, disease duration, outcome and cause of death. We compared all cause and respiratory mortality between RA controls and RA-ILD patients, assessing the influence of specific drugs on mortality in four quartiles based on year of diagnosis. RESULTS A total of 290 RA-ILD patients were identified. All cause (respiratory) mortality was increased at 30% (18%) compared with controls 21% (7%) (P =0.02). Overall, prognosis improved over quartiles with median age at death rising from 63 years to 78 years (P =0.01). No effect on mortality was detected as a result of DMARD use in RA-ILD. Relative risk (RR) of death from any cause was increased among patients who had received anti-TNF therapy [2.09 (1.1-4.0)] P =0.03, while RR was lower in those treated with rituximab [0.52(0.1-2.1)] or mycophenolate [0.65 (0.2-2.0)]. Patients receiving rituximab as their first biologic had longer three (92%), five (82%) and seven year (80%) survival than those whose first biologic was an anti-TNF agent (82%, 76% and 64%, respectively) (P =0.037). DISCUSSION This large retrospective multicentre study demonstrates survival of patients with RA-ILD has improved. This may relate to the increasing use of specific immunosuppressive and biologic agents.
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Affiliation(s)
- Clive A Kelly
- Department of Cellular Medicine, University of Newcastle upon Tyne, Gateshead, UK
| | - Mohamed Nisar
- Rheumatology, Burton Hospitals NHS Foundation Trust, Burton on Trent, UK
| | - Suba Arthanari
- Rheumatology, Burton Hospitals NHS Foundation Trust, Burton on Trent, UK
| | - Sarah Carty
- Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Felix A Woodhead
- Chest Medicine, University Hospital Leicester NHS Foundation Trust, Leicester, UK
| | - Alex Price-Forbes
- Chest Medicine, University Hospital Leicester NHS Foundation Trust, Leicester, UK
| | | | | | | | - Neil Basu
- Rheumatology, Royal Hospital, Aberdeen, UK
| | - Julie Dawson
- Rheumatology, St Helens and Knowsley Teaching Hospitals NHS Trust, Knowsley, UK
| | - Nav Sathi
- Rheumatology, St Helens and Knowsley Teaching Hospitals NHS Trust, Knowsley, UK
| | - Yasmin Ahmad
- Rheumatology, North Wales Hospitals Trust, Betsy-Coed, UK
| | - Evelyn Palmer
- Medicine, Northern Deanery, Health Education North East, Newcastle, UK
| | - Kundan Iqbal
- Medicine, Northern Deanery, Health Education North East, Newcastle, UK
| | | | - Gouri Koduri
- Rheumatology, Southend Hospital, Westcliff-on-Sea, UK
| | - Adam Young
- Rheumatology, St Albans City Hospital, St Albans, UK
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29
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Manfredi A, Cassone G, Luppi F, Atienza-Mateo B, Cavazza A, Sverzellati N, González-Gay MA, Salvarani C, Sebastiani M. Rheumatoid arthritis related interstitial lung disease. Expert Rev Clin Immunol 2021; 17:485-497. [PMID: 33779447 DOI: 10.1080/1744666x.2021.1905524] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Interstitial lung disease (ILD) represents a frequent extra-articular manifestation of rheumatoid arthritis (RA) deeply impacting both quality of life and overall prognosis. Areas covered: A literature search was performed including PubMed, Embase, Scopus, and Web of Science. Many retrospective studies investigated the possible risk factors for RA-related ILD (RA-ILD), aiming to identify patients at risk. Among them, males, smokers, positivity of anti-citrullinated peptide antibodies have been associated with RA-ILD, such as some genetic haplotypes. Usual interstitial pneumonia is the histologic and radiologic pattern most frequently observed, followed by nonspecific interstitial pneumonia. Since lung involvement can represent the RA onset, an early differential diagnosis with idiopathic interstitial pneumonia can be difficult or sometimes impossible. High-resolution computed tomography represents the gold standard for ILD diagnosis, while multidisciplinary discussion should be required to assess disease staging, severity and progression. Expert opinion: Management of RA-ILD patients is challenging due to the lack of evidence-based data regarding both assessment and treatment. Moreover, the high variability of clinical presentation and evolution makes it difficult to establish the correct therapeutic strategy. Currently, multidisciplinary approach, including at least rheumatologists, pulmonologists, and radiologists, is desirable to define therapy and follow-up strategies.
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Affiliation(s)
- Andreina Manfredi
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico Di , Modena, Italy
| | - Giulia Cassone
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico Di , Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabrizio Luppi
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy.,Department of Medicine and Surgery, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Belen Atienza-Mateo
- Department of Rheumatology, Hospital Universitario Marques De Valdecilla, IDIVAL, University of Cantabria Santander, Santander, Spain
| | - Alberto Cavazza
- Pathology Unit, IRCCS Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Nicola Sverzellati
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (Dimec), University of Parma, Parma, Italy
| | - Miguel A González-Gay
- Department of Rheumatology, Hospital Universitario Marques De Valdecilla, IDIVAL, University of Cantabria Santander, Santander, Spain
| | - Carlo Salvarani
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico Di , Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.,Rheumatology Unit, IRCCS Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Sebastiani
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico Di , Modena, Italy
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Fernández-Díaz C, Atienza-Mateo B, Castañeda S, Melero-Gonzalez RB, Ortiz-SanJuan F, Loricera J, Casafont-Solé I, Rodríguez-García S, Aguilera-Cros C, Villa-Blanco I, Raya-Alvarez E, Ojeda-García C, Bonilla G, López-Robles A, Arboleya L, Narváez J, Cervantes E, Maiz O, Alvarez-Rivas MN, Cabezas I, Salgado E, Hidalgo-Calleja C, Fernández S, Fernández JC, Ferraz-Amaro I, González-Gay MA, Blanco R. ABATACEPT IN MONOTHERAPY VERSUS COMBINED IN INTERSTITIAL LUNG DISEASE OF RHEUMATOID ARTHRITIS. MULTICENTER STUDY OF 263 CAUCASIAN PATIENTS. Rheumatology (Oxford) 2021; 61:299-308. [PMID: 33779697 DOI: 10.1093/rheumatology/keab317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To assess the efficacy and safety of abatacept (ABA) in monotherapy (ABAMONO) versus combined-ABA, ABA plus methotrexate (ABAMTX) or ABA plus non-MTX conventional-DMARDs (ABANON-MTX), in Rheumatoid Arthritis (RA) patients with Interstitial Lung Disease (ILD) (RA-ILD). METHODS Restrospective multicenter study of RA-ILD Caucasian patients treated with ABA. We analyzed in the three groups (ABAMONO, ABAMTX, ABANON-MTX) the following outcome variables: a) Dyspnea b) FVC and DLCO c) chest HRCT, d) DAS28-ESR, e) corticosteroid-sparing effect, f) ABA retention and side-effects. Differences between basal and final follow-up were evaluated. Multivariable linear regression was used to assess the differences between the three groups. RESULTS We studied 263 RA-ILD patients (mean age 64.6±10 years) [ABAMONO (n = 111), ABAMTX (n = 46) and ABANON-MTX (n = 106)]. At baseline, ABAMONO patients were older (67±10 years) and took higher prednisone dose (10 [IQR 5-15] mg/day). At that time, there were no statistically significant differences in sex, seropositivity, ILD patterns, FVC and DLCO or disease duration. Following treatment, in all groups, most patients experienced stabilization or improvement in FVC, DLCO, dyspnoea, chest-HRCT as well as improvement in DAS28-ESR. A statistically significant difference between basal and final follow-up was only found in corticosteroid-sparing effect in the group on combined-ABA (ABAMTX or ABANON-MTX). However, in the multivariable analysis, there were no differences in any outcome variables between the three groups. CONCLUSION In Caucasian individuals with RA-ILD, ABA in monotherapy or combined with MTX or with other conventional-DMARDS seems to be equally effective and safe. However, a corticosteroid-sparing effect is only observed with combined-ABA.
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Affiliation(s)
| | | | - Santos Castañeda
- HU La Princesa, IIS-Princesa, Cátedra UAM-Roche (EPID-Future), UAM, Madrid
| | | | | | - Javier Loricera
- HU Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ricardo Blanco
- HU Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander
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31
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Targeted therapies in interstitial lung disease secondary to systemic autoimmune rheumatic disease. Current status and future development. Autoimmun Rev 2020; 20:102742. [PMID: 33333235 DOI: 10.1016/j.autrev.2020.102742] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/25/2020] [Indexed: 12/22/2022]
Abstract
Autoimmune rheumatic diseases (ARD) are characterized by systemic manifestations and multiple organ involvement, including the lung. Interstitial Lung Disease (ILD) is a cardinal manifestation of lung involvement in patients with ARD and is associated with significant morbidity and mortality. Corticosteroids and immunosuppressive drugs are used as first -line treatment. Targeted therapies, such as biological disease modifying antirheumatic drugs (DMARDS) and anti- fibrotic agents are new treatment options. In this review we discuss the role of targeted therapies in patients with ILD secondary to ARD.
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32
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Fernández-Díaz C, Castañeda S, Melero-González RB, Ortiz-Sanjuán F, Juan-Mas A, Carrasco-Cubero C, Casafont-Solé I, Olivé A, Rodríguez-Muguruza S, Almodóvar-González R, Castellanos-Moreira R, Rodríguez-García SC, Aguilera-Cros C, Villa I, Ordóñez-Palau S, Raya-Alvarez E, Morales-Garrido P, Ojeda-García C, Moreno-Ramos MJ, Bonilla Hernán MG, Hernández Rodríguez I, López-Corbeto M, Andreu JL, Jiménez de Aberásturi JRD, Ruibal-Escribano A, Expósito-Molinero R, Pérez-Sandoval T, López-Robles AM, Carreira-Delgado P, Mena-Vázquez N, Urruticoechea-Arana A, Peralta-Ginés C, Arboleya-Rodríguez L, Narváez García FJ, Palma-Sánchez D, Cervantes Pérez EC, Maiz-Alonso O, Alvarez-Rivas MN, Fernández-Melón J, Vela Casasempere P, Cabezas-Rodríguez I, Castellvi-Barranco I, González-Montagut C, Blanco-Madrigal J, Del Val-Del Amo N, Fito MC, Rodríguez-Gómez M, Salgado-Pérez E, García-Magallón B, Hidalgo-Calleja C, López-Sánchez R, Fernández-Aguado S, Fernández-López JC, Castro-Oreiro S, Serrano-García I, García-Valle A, Romero-Yuste S, Expósito-Pérez L, Pérez-Albadalejo L, García-Aparicio A, Quillis-Marti N, Bernal-Vidal JA, Loricera-García J, Hernández JL, González-Gay MA, Blanco R. Abatacept in interstitial lung disease associated with rheumatoid arthritis: national multicenter study of 263 patients. Rheumatology (Oxford) 2020; 59:3906-3916. [DOI: 10.1093/rheumatology/keaa621] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/01/2020] [Indexed: 01/11/2023] Open
Abstract
Abstract
Objective
To assess the efficacy of abatacept (ABA) in RA patients with interstitial lung disease (ILD) (RA-ILD).
Methods
This was an observational, multicentre study of RA-ILD patients treated with at least one dose of ABA. ILD was diagnosed by high-resolution CT (HRCT). We analysed the following variables at baseline (ABA initiation), 12 months and at the end of the follow-up: Modified Medical Research Council (MMRC) scale (1-point change), forced vital capacity (FVC) or diffusion lung capacity for carbon monoxide (DLCO) (improvement or worsening ≥10%), HRCT, DAS on 28 joints evaluated using the ESR (DAS28ESR) and CS-sparing effect.
Results
We studied 263 RA-ILD patients [150 women/113 men; mean (s.d.) age 64.6 (10) years]. At baseline, they had a median duration of ILD of 1 (interquartile range 0.25–3.44) years, moderate or severe degree of dyspnoea (MMRC grade 2, 3 or 4) (40.3%), FVC (% of the predicted) mean (s.d.) 85.9 (21.8)%, DLCO (% of the predicted) 65.7 (18.3) and DAS28ESR 4.5 (1.5). The ILD patterns were: usual interstitial pneumonia (UIP) (40.3%), non-specific interstitial pneumonia (NSIP) (31.9%) and others (27.8%). ABA was prescribed at standard dose, i.v. (25.5%) or s.c. (74.5%). After a median follow-up of 12 (6–36) months the following variables did not show worsening: dyspnoea (MMRC) (91.9%); FVC (87.7%); DLCO (90.6%); and chest HRCT (76.6%). A significant improvement of DAS28ESR from 4.5 (1.5) to 3.1 (1.3) at the end of follow-up (P < 0.001) and a CS-sparing effect from a median 7.5 (5–10) to 5 (2.5–7.5) mg/day at the end of follow-up (P < 0.001) was also observed. ABA was withdrawn in 62 (23.6%) patients due to adverse events (n = 30), articular inefficacy (n = 27), ILD worsening (n = 3) and other causes (n = 2).
Conclusion
ABA may be an effective and safe treatment for patients with RA-ILD.
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Affiliation(s)
| | - Santos Castañeda
- Rheumatology Cátedra UAM-Roche (EPID-Future) HU La Princesa, IIS-Princesa, UAM, Madrid
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - José L Hernández
- Rheumatology, HU Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander
| | | | - Ricardo Blanco
- Rheumatology, HU Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander
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Manfredi A, Cassone G, Furini F, Gremese E, Venerito V, Atzeni F, Arrigoni E, Della Casa G, Cerri S, Govoni M, Petricca L, Iannone F, Salvarani C, Sebastiani M. Tocilizumab therapy in rheumatoid arthritis with interstitial lung disease: a multicentre retrospective study. Intern Med J 2020; 50:1085-1090. [DOI: 10.1111/imj.14670] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/29/2019] [Accepted: 10/20/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Andreina Manfredi
- Rheumatology Unit University of Modena and Reggio Emilia, Univeritary Hospital Policlinico of Modena Modena Italy
| | - Giulia Cassone
- Rheumatology Unit University of Modena and Reggio Emilia, Univeritary Hospital Policlinico of Modena Modena Italy
- Clinical and Experimental Medicine PhD Program University of Modena and Reggio Emilia Modena Italy
- Rheumatology Unit IRCCS Arcispedale Santa Maria Nuova, Universitary Hospital Policlinico of Modena Reggio Emilia Italy
| | - Federica Furini
- Department of Medical Sciences, Division of Rheumatology Santa Anna University Hospital Ferrara Italy
| | - Elisa Gremese
- Division of Rheumatology, Institute of Rheumatology Catholic University of the Sacred Heart Rome Italy
| | | | | | - Eugenio Arrigoni
- Rheumatology Unit ERI Medicine, Hospital of Piacenza Piacenza Italy
| | | | - Stefania Cerri
- Respiratory Disease Unit University of Modena and Reggio Emilia, Universitary Hospital Policlinico of Modena Modena Italy
| | - Marcello Govoni
- Department of Medical Sciences, Division of Rheumatology Santa Anna University Hospital Ferrara Italy
| | - Luca Petricca
- Division of Rheumatology, Institute of Rheumatology Catholic University of the Sacred Heart Rome Italy
| | | | - Carlo Salvarani
- Rheumatology Unit University of Modena and Reggio Emilia, Univeritary Hospital Policlinico of Modena Modena Italy
- Rheumatology Unit IRCCS Arcispedale Santa Maria Nuova, Universitary Hospital Policlinico of Modena Reggio Emilia Italy
| | - Marco Sebastiani
- Rheumatology Unit University of Modena and Reggio Emilia, Univeritary Hospital Policlinico of Modena Modena Italy
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Carrasco Cubero C, Chamizo Carmona E, Vela Casasempere P. Systematic Review of the Impact of Drugs on Diffuse Interstitial Lung Disease Associated with Rheumatoid Arthritis. REUMATOLOGIA CLINICA 2020; 17:S1699-258X(20)30111-X. [PMID: 32571732 DOI: 10.1016/j.reuma.2020.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/05/2020] [Accepted: 04/22/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To review the available evidence on the impact of rheumatoid arthritis (RA) treatments in associated diffuse interstitial lung disease (ILD). METHODS Systematic review of studies evaluating the impact of pharmacological treatment in patients with RA and ILD. A bibliographic search in MEDLINE, EMBASE and Cochrane, a selection of articles and the methodological quality assessment (FLC 3.0 OSTEBA) and grading of the level of evidence (SING) of the selected articles were performed. RESULTS 1,720 references were identified in primary search and 7 in manual or indirect. Forty-three articles were included: 7 systematic reviews, 2 randomized clinical trials, 5 cohort studies, 8 case-control studies and 21 case series. Methotrexate (MTX) and leflunomide (LEF) do not increase incidence, complications or mortality due to ILD. Although the results are not uniform, anti-TNF have often had worse outcomes in incidence, progression and mortality due to ILD than MTX, LEF, abatacept (ABA) and rituximab (RTX). The evidence found is scarce for JAK kinase and antifibrotic inhibitors, and controversial for IL-6 inhibitors. CONCLUSIONS There is no evidence that MTX or LEF worsens the prognosis of patients with AR-EPID. RTX and ABA seem to have better results than other biologicals, such as anti-TNF, often achieving stabilization and, in some cases, the improvement of ILD in patients with RA.
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35
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Non-anti-TNF biologic agents are associated with slower worsening of interstitial lung disease secondary to rheumatoid arthritis. Clin Rheumatol 2020; 40:133-142. [DOI: 10.1007/s10067-020-05227-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 01/30/2023]
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36
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Eliadou E, Moleiro J, Ribaldone DG, Astegiano M, Rothfuss K, Taxonera C, Ghalim F, Carbonnel F, Verstockt B, Festa S, Maia L, Berrozpe A, Zagorowicz E, Savarino E, Ellul P, Vavricka SR, Calvo M, Koutroubakis I, Hoentjen F, Salazar LF, Callela F, Cañete Pizarro F, Soufleris K, Sonnenberg E, Cavicchi M, Wypych J, Hommel C, Ghiani A, Fiorino G. Interstitial and Granulomatous Lung Disease in Inflammatory Bowel Disease Patients. J Crohns Colitis 2020; 14:480-489. [PMID: 31602473 DOI: 10.1093/ecco-jcc/jjz165] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Interstitial lung [ILD] disease and granulomatous lung disease [GLD] are rare respiratory disorders that have been associated with inflammatory bowel disease [IBD]. Clinical presentation is polymorphic and aetiology is unclear. METHODS This was an ECCO-CONFER project. Cases of concomitant ILD or GLD and IBD, or drug-induced ILD/GLD, were collected. The criteria for diagnosing ILD and GLD were based on definitions from the American Thoracic Society and the European Respiratory Society and on the discretion of reporting clinician. RESULTS We identified 31 patients with ILD. The majority had ulcerative colitis [UC] [n = 22]. Drug-related ILD was found in 64% of these patients, 25 patients [80.6%] required hospitalisation, and one required non-invasive ventilation. The causative drug was stopped in all drug-related ILD, and 87% of patients received systemic steroids. At follow-up, 16% of patients had no respiratory symptoms, 16% had partial improvement, 55% had ongoing symptoms, and there were no data in 13%. One patient was referred for lung transplantation, and one death from lung fibrosis was reported. We also identified 22 GLD patients: most had Crohn's disease [CD] [n = 17]. Drug-related GLD was found in 36% of patients and 10 patients [45.4%] required hospitalisation. The causative drug was stopped in all drug-related GLD, and 81% of patients received systemic steroids. Remission of both conditions was achieved in almost all patients. CONCLUSIONS ILD and GLD, although rare, can cause significant morbidity. In our series, over half of cases were drug-related and therefore focused pharmacovigilance is needed to identify and manage these cases.
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Affiliation(s)
- Elena Eliadou
- Gastroenterology Department, Manchester Royal Infirmary, Manchester UK
| | - Joana Moleiro
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | | | - Marco Astegiano
- Gastroenterologia-U, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Katja Rothfuss
- Robert-Bosch Hospital, Department of Gastroenterology, Hepatology and Endocrinology, Stuttgart, Germany
| | - Carlos Taxonera
- Department of Gastroenterology, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain
| | - Fahd Ghalim
- Gastroenterology Department, Kremlin Bicêtre Hospital, University Paris Sud, Paris, France
| | - Franck Carbonnel
- Gastroenterology Department, Kremlin Bicêtre Hospital, University Paris Sud, Paris, France
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, and Department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Stefano Festa
- Ospedale San Filippo Neri, UOS Malattie Infiammatorie Croniche Intestinali Porto, Portugal
| | - Luís Maia
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Ana Berrozpe
- IBD Unit, Bellvitge's Hospital, Barcelona, SpainWarsaw, Poland
| | - Edyta Zagorowicz
- Maria Sklodowska Curie Memorial Cancer Centre and Institute of Oncology, Department of Gastroenterology,Warsaw, Poland
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology,University of Padua, Padua, Italy
| | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Valleta, Malta
| | - Stephan R Vavricka
- Department of Gastroenterology and Hepatology, Center for Gastroenterology and Hepatology, Zurich, Switzerland
| | - Marta Calvo
- Gastroenterology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Frank Hoentjen
- Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Francesca Callela
- UOC Gastroenterologia, Ospedale San Giuseppe, Empoli, Firenze, Italy
| | | | - Konstantinos Soufleris
- Department of Gastroenterology, Theagenion Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - Maryan Cavicchi
- Department of Gatroenterology, Clinique de Bercy, Creteil, France
| | - Joanna Wypych
- Surgery & Gastroenterology Department, Copernicus Hospital, Gdansk, Poland
| | - Christophe Hommel
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Yvoir, Belgium,Catholic University of Louvain, Brussels, Belgium
| | - Alessandro Ghiani
- Schillerhoehe Lung Clinic [Robert-Bosch-Hospital], Department of Pneumology and Respiratory Medicine, Gerlingen, Germany
| | - Gionata Fiorino
- Humanitas Clinical and Research Center, Gastroenterology Department, Rozzano, Milan, Italy.,Humanitas University, Department of Biomedical Sciences, Rozzano, Milan, Italy
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England BR, Hershberger D. Management issues in rheumatoid arthritis-associated interstitial lung disease. Curr Opin Rheumatol 2020; 32:255-263. [PMID: 32141954 PMCID: PMC7331796 DOI: 10.1097/bor.0000000000000703] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Summarize recent evidence on the identification and management of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). RECENT FINDINGS Clinical and subclinical interstitial lung disease (ILD) are frequent extra-articular manifestations of rheumatoid arthritis (RA). Better means of identifying and treating RA-ILD are needed to improve the prognosis, with a median survival of only 3-7 years after diagnosis. Several serum biomarkers are currently being evaluated for their ability to detect RA-ILD. Thorough evaluation and multidisciplinary discussion remains the gold standard for establishing the diagnosis of RA-ILD. Management is challenging with most RA disease-modifying antirheumatic drugs (DMARDs) linked to pneumonitis. Methotrexate is typically avoided in clinically significant ILD, although alternative therapies including leflunomide and biologic DMARDs also carry risks in RA-ILD. Antifibrotics appear to slow the progression of ILD, and a large phase II trial exclusively in RA-ILD is underway. In addition, smoking cessation, pulmonary rehabilitation, oxygen therapy, managing comorbidities, and lung transplantation evaluation are vital to improving patient outcomes in RA-ILD. SUMMARY With little high-quality evidence to guide the management of RA-ILD, multidisciplinary teams with expertise in RA-ILD are highly valuable for diagnosing and treating RA-ILD. Clinical and translational research in RA-ILD is needed to fill the many evidence gaps.
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Affiliation(s)
- Bryant R. England
- Division of Rheumatology & Immunology; Department of Internal Medicine; University of Nebraska Medical Center (UNMC) & VA Nebraska-Western Iowa Health Care System
| | - Daniel Hershberger
- Division of Pulmonary, Critical Care, Sleep, & Allergy; Department of Internal Medicine; UNMC
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Duarte AC, Porter JC, Leandro MJ. The lung in a cohort of rheumatoid arthritis patients-an overview of different types of involvement and treatment. Rheumatology (Oxford) 2020; 58:2031-2038. [PMID: 31089697 DOI: 10.1093/rheumatology/kez177] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/04/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Lung involvement in RA has several manifestations and is a major cause of morbidity and mortality. The aim of this study was to characterize the different types of lung disease and response to treatment in a UK cohort of RA patients. METHODS RA patients who had undergone high resolution CT scans of the lung were identified and scans reviewed. Demographic data, RA features, complementary exams and treatments were recorded for those with radiological evidence of lung involvement. Descriptive analysis was performed, and Mann-Whitney U and χ2 tests were used for comparison between different radiological subtypes. RESULTS Lung disease was reported in 87 (7.7%) of 1129 RA patients, usually (97.7%) post-dating articular symptoms. Most patients had positive RF (74/84; 88.1%) and ACPA (72/82; 87.7%). Interstitial lung disease (ILD) was the most common pattern, reported in 45 (51.7%) patients. Drug-induced lung disease was reported in 2 of 64 (3.1%) patients treated with MTX. Rituximab was used in 26 (57.8%) patients with ILD, with evidence of disease improvement or stabilization in patients with non-specific interstitial pneumonia and organizing pneumonia. During lung disease follow-up (6.7 ± 4.1 years), 22 (25.3%) patients were admitted to hospital with respiratory infections, with 14 (63.6%) of them having underlying bronchiectasis. Lung disease-related mortality was estimated at 8%. CONCLUSION ILD was the most prevalent manifestation of lung involvement in RA and was associated with higher mortality. Immunosuppressive drugs used in RA were rarely associated with lung toxicity, and rituximab demonstrated promising results for the treatment of RA-ILD.
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Affiliation(s)
- Ana C Duarte
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Joanna C Porter
- UCL Respiratory, London, UK.,Center for Interstitial Lung Disease, London, UK
| | - Maria J Leandro
- Center for Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
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Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease: Lights and Shadows. J Clin Med 2020; 9:jcm9041082. [PMID: 32290218 PMCID: PMC7230307 DOI: 10.3390/jcm9041082] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/29/2020] [Accepted: 04/03/2020] [Indexed: 12/16/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic and systemic inflammatory disease affecting 0.5–1% of the population worldwide. Interstitial lung disease (ILD) is a serious pulmonary complication of RA and it is responsible for 10–20% of mortality, with a mean survival of 5–8 years. However, nowadays there are no therapeutic recommendations for the treatment of RA-ILD. Therapeutic options for RA-ILD are complicated by the possible pulmonary toxicity of many disease modifying anti-rheumatic drugs (DMARDs) and by their unclear efficacy on pulmonary disease. Therefore, joint and lung involvement should be evaluated independently of each other for treatment purposes. On the other hand, some similarities between RA-ILD and idiopathic pulmonary fibrosis and the results of the recent INBIULD trial suggest a possible future role for antifibrotic agents. From this perspective, we review the current literature describing the pulmonary effects of drugs (immunosuppressants, conventional, biological and target synthetic DMARDs and antifibrotic agents) in patients with RA and ILD. In addition, we suggest a framework for the management of RA-ILD patients and outline a research agenda to fill the gaps in knowledge about this challenging patient cohort.
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40
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Ono T, Iwasaki T, Terada Y, Abe K, Lee J, Mochizuki M, Miyata K. Serum KL-6 elevation in a uveitis patient with Behçet's disease treated with adalimumab. Am J Ophthalmol Case Rep 2020; 18:100660. [PMID: 32215341 PMCID: PMC7083778 DOI: 10.1016/j.ajoc.2020.100660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/01/2019] [Accepted: 03/09/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose To report a case of uveitis with Behçet's disease in which serum levels of Krebs von den Lungen (KL)-6, a marker of interstitial lung disease, were elevated during treatment with adalimumab and returned to baseline after discontinuation of the agent. Observations A 67-year-old man complaining of vision disturbance was referred to our hospital. The patient had a history of recurrent episodes of bilateral uveitis and oral ulcers, and had been diagnosed with Behçet's disease. While uveitis activity was not well controlled under administration of oral prednisolone and cyclosporin, cataract of the right eye developed and required surgery. Biweekly administration of adalimumab 40 mg was therefore initiated with prednisolone at 15 mg/day. Uveitis became well controlled and cataract surgery was successfully carried out for the right eye. However, serum KL-6 gradually elevated to 1002 U/ml by 6 months after adalimumab initiation and 1277 U/ml at 9 months. Because serum KL-6 >1000 U/ml has been reported to predict interstitial lung disease, we discontinued adalimumab and started cyclosporine at 100 mg/day. Serum KL-6 gradually decreased and returned to baseline levels, no interstitial lung disease developed and exacerbation of uveitis was avoided. Conclusions and importance This case implies the clinical importance of monitoring serum KL-6 in patents with non-infectious uveitis being treated with adalimumab.
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Affiliation(s)
- Takashi Ono
- Miyata Eye Hospital, Miyazaki, Japan.,Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Yukiko Terada
- Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
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41
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Cassone G, Manfredi A, Atzeni F, Venerito V, Vacchi C, Picerno V, Furini F, Erre GL, Tomietto P, Fedele AL, Della Casa G, Nucera V, Giannitti C, Salvarani C, Sebastiani M. Safety of Abatacept in Italian Patients with Rheumatoid Arthritis and Interstitial Lung Disease: A Multicenter Retrospective Study. J Clin Med 2020; 9:jcm9010277. [PMID: 31963908 PMCID: PMC7019755 DOI: 10.3390/jcm9010277] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/10/2020] [Accepted: 01/16/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Treatment of rheumatoid arthritis (RA)-related interstitial lung disease (ILD) is challenging, and many conventional and biologic disease-modifying anti-rheumatic drugs (DMARDs) have been associated with ILD development or progression. The aim of this multicentric retrospective study was to analyze the evolution of ILD in Italian RA-ILD patients treated with abatacept (ABA). Methods: All RA-ILD patients treated with ABA for at least six months were retrospectively evaluated. Serology, previous and concurrent therapies, chest high-resolution computer tomography (HRCT), forced vital capacity (FVC), and lung diffusion of carbon monoxide (CO, DLCO) were collected. Results: Forty-four patients were included; HRCT, FVC, and DLCO were analyzed at baseline, at one year, and at the end of follow-up. A remission or a low disease activity of RA was reached in 41/44 patients. Overall, FVC and DLCO remained stable or increased in 86.1% and 91.7% of patients, respectively, while HRCT was stable or improved in 81.4% of them. Previous and concurrent treatments, in particular, methotrexate, serology, age, sex, joint and lung disease duration were not associated with the outcome at univariate analysis. Conclusion: The management of RA-ILD patients remains a critical unmet medical need. Waiting for prospective controlled studies, ABA has shown a good safety profile in our cohort of Italian RA-ILD patients.
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Affiliation(s)
- Giulia Cassone
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy; (G.C.); (C.V.)
| | - Andreina Manfredi
- Chair and Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41121 Modena, Italy (C.S.)
| | - Fabiola Atzeni
- Rheumatology Unit, University of Messina, 98121 Messina, Italy; (F.A.)
| | - Vincenzo Venerito
- Rheumatology Unit, Interdisciplinary Department of Medicine, University of Bari, 70121 Bari, Italy;
| | - Caterina Vacchi
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy; (G.C.); (C.V.)
| | - Valentina Picerno
- Rheumatology Institute of Lucania (IReL) and Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, 85100 Potenza, Italy;
| | - Federica Furini
- Department of Medical Sciences, Division of Rheumatology, Santa Anna University Hospital, 44100 Ferrara, Italy;
| | - Gian Luca Erre
- Rheumatology Unit, Azienda Ospedaliero-Universitaria di Sassari, 07010 Sassari, Italy;
| | - Paola Tomietto
- Department of Clinical Medicine, Rheumatology Unit, Azienda Sanitaria Universitaria Integrata di Trieste, 34121 Trieste, Italy;
| | - Anna Laura Fedele
- Rheumatology Unit, Policlinico Gemelli Foundation, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Giovanni Della Casa
- Radiology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41121 Modena, Italy
| | - Valeria Nucera
- Rheumatology Unit, University of Messina, 98121 Messina, Italy; (F.A.)
| | | | - Carlo Salvarani
- Chair and Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41121 Modena, Italy (C.S.)
| | - Marco Sebastiani
- Chair and Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41121 Modena, Italy (C.S.)
- Correspondence: ; Tel.: +39-059-4225636; Fax: +39-059-4223007
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Wu EK, Henkes ZI, McGowan B, Bell RD, Velez MJ, Livingstone AM, Ritchlin CT, Schwarz EM, Rahimi H. TNF-Induced Interstitial Lung Disease in a Murine Arthritis Model: Accumulation of Activated Monocytes, Conventional Dendritic Cells, and CD21 +/CD23 - B Cell Follicles Is Prevented with Anti-TNF Therapy. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2019; 203:2837-2849. [PMID: 31659014 PMCID: PMC6989047 DOI: 10.4049/jimmunol.1900473] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/29/2019] [Indexed: 12/29/2022]
Abstract
Interstitial lung disease (ILD) is a well-known extra-articular manifestation of rheumatoid arthritis (RA). RA-associated ILD (RA-ILD) exists on a wide spectrum, with variable levels of inflammatory and fibrotic activity, although all subtypes are regarded as irreversible pathologic conditions. In both articular and pulmonary manifestations, TNF is a significant pathogenic factor. Whereas anti-TNF therapy alleviates joint pathologic conditions, it exacerbates fibrotic RA-ILD. The TNF-transgenic (TNF-Tg) murine model of RA develops both inflammatory arthritis and an ILD that mimics a cellular nonspecific interstitial pneumonia pattern dominated by an interstitial accumulation of inflammatory cells with minimal-to-absent fibrosis. Given the model's potential to elucidate the genesis of inflammatory RA-ILD, we aim to achieve the following: 1) characterize the cellular accumulations in TNF-Tg lungs, and 2) assess the reversibility of inflammatory ILD following anti-TNF therapy known to resolve TNF-Tg inflammatory arthritis. TNF-Tg mice with established disease were randomized to anti-TNF or placebo therapy and evaluated with imaging, histology, and flow cytometric analyses, together with wild-type controls. Flow cytometry of TNF-Tg versus wild-type lungs revealed significant increases in activated monocytes, conventional dendritic cells, and CD21+/CD23- B cells that are phenotypically distinct from the B cells in inflamed nodes, which are known to accumulate in joint-draining lymph nodes. In contrast to human RA-ILD, anti-TNF treatment significantly alleviated both joint and lung inflammation. These results identify a potential role for activated monocytes, conventional dendritic cells, and CD21+/CD23- B cells in the genesis of RA-ILD, which exist in a previously unknown, reversible, prefibrotic stage of the disease.
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Affiliation(s)
- Emily K Wu
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642
- Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642
| | - Zoe I Henkes
- Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642
| | - Brion McGowan
- Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642
| | - Richard D Bell
- Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642
| | - Moises J Velez
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642
| | - Alexandra M Livingstone
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642
- David H. Smith Center for Vaccine Biology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642
| | - Christopher T Ritchlin
- Allergy, Immunology, and Rheumatology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642
| | - Edward M Schwarz
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642
- Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642; and
| | - Homaira Rahimi
- Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642;
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642
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Kang EH, Jin Y, Desai RJ, Liu J, Sparks JA, Kim SC. Risk of exacerbation of pulmonary comorbidities in patients with rheumatoid arthritis after initiation of abatacept versus TNF inhibitors: A cohort study. Semin Arthritis Rheum 2019; 50:401-408. [PMID: 31813561 DOI: 10.1016/j.semarthrit.2019.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/23/2019] [Accepted: 11/08/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Biologic agents may pose a potential risk for exacerbations of pulmonary comorbidities in rheumatoid arthritis (RA) patients. METHODS Using U.S. Medicare and Truven MarketScan databases, we identified three cohorts of RA patients with interstitial lung disease (ILD), chronic obstructive pulmonary disease (COPD), or asthma who initiated abatacept or a TNF inhibitor (TNFi). The primary outcome was a composite exacerbation of individual pulmonary comorbidities based on inpatient or emergency department (ED) visits due to exacerbation of the given pulmonary comorbidity. To adjust for >60 baseline confounders, we used propensity-score fine stratification (PSS) and weighting. Negative binomial regression model estimated a cohort-specific incidence rate ratio (IRR) and 95% confidence interval (CI) of the primary outcome per database, comparing abatacept versus TNFi. Database-specific IRRs were combined using a random-effects meta-analysis. RESULTS We identified 3,295 ILD, 7,161 COPD, and 5,613 asthma patients with RA who initiated either abatacept or a TNFi. IR of composite exacerbation was high in all three pulmonary cohorts but highest in COPD cohort (3.59-11.80 per 100 person-years in ILD, 20.68-34.97 in COPD, and 4.66-13.78 in asthma). After PSS weighting, the combined IRR (95%CI) in abatacept initiators versus TNFi initiators was 0.44 (0.18-1.09) for ILD exacerbation, 0.91 (0.80-1.03) for COPD exacerbation, and 0.81 (0.54-1.22) for asthma exacerbation. CONCLUSION Among patients with RA and pulmonary comorbidities, exacerbations requiring inpatient or ED visits occurred frequently after initiating abatacept or TNFi. Overall, we found no significant difference in the risk of ILD, COPD or asthma exacerbation between abatacept and TNFi initiators, but precision of our estimates is limited.
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Affiliation(s)
- Eun Ha Kang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA 02120, USA; Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yinzhu Jin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA 02120, USA
| | - Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA 02120, USA
| | - Jun Liu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA 02120, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA 02120, USA; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Amigues I, Ramadurai D, Swigris JJ. Current Perspectives On Emerging Biomarkers For Rheumatoid Arthritis-Associated Interstitial Lung Disease. Open Access Rheumatol 2019; 11:229-235. [PMID: 31686925 PMCID: PMC6800546 DOI: 10.2147/oarrr.s166070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/24/2019] [Indexed: 12/12/2022] Open
Abstract
Rheumatoid arthritis (RA) is a common systemic autoimmune disease whose fibro-inflammatory manifestations may affect a number of tissues and organs, including the lungs. In fact, interstitial lung disease (ILD) is a leading cause of mortality among patients with RA. RA-related interstitial lung disease (RA-ILD) most often presents in an injury pattern called usual interstitial pneumonia (UIP), which portends a relatively worse prognosis than other less commonly occurring patterns of RA-ILD, like non-specific interstitial pneumonia (NSIP). Biomarkers from serum or bronchoalveolar lavage fluid could aid in the identification of patients at risk for RA-ILD, the detection of patients most likely to develop the UIP pattern of RA-ILD, and the prediction of disease behaviour over time. Notably, the use of highly sensitive serologic biomarkers, including rheumatoid factor (RF) and antibodies targeting cyclic citrullinated peptides, while somewhat specific for RA joint disease, have only limited utility as biomarkers for RA-ILD. Candidate biomarkers for RA-ILD include these and other autoantibodies as well as certain genes and molecules that hold promise as biomarkers in other forms of ILD. In this manuscript, we summarize the state of knowledge on biomarkers for the development and progression of RA-ILD.
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Affiliation(s)
- Isabelle Amigues
- Division of Rheumatology, National Jewish Health, Denver, CO, USA
| | - Deepa Ramadurai
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jeffrey J Swigris
- Division of Pulmonary, Critical Care and Sleep Medicine, Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA
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Abstract
Pulmonary involvement in patients with rheumatoid arthritis, in particular interstitial lung diseases (RA-ILD) is of great clinical importance. Patients should be asked about symptoms of pulmonary involvement and the lungs should be clinically examined even during the diagnostic procedure and regularly during the course of the disease. Before initiation of a basic pharmacological treatment an X‑ray examination of thoracic organs is obligatory. In cases of conspicuous clinical or radiological findings, extended diagnostic procedures with lung function testing (body plethysmography with diffusion measurement) and high resolution computed tomography (CT) should be performed, depending on the findings. The differential diagnosis of interstitial lung alterations in patients with RA is broad and should consider side effects of the basis medication in addition to infectious causes. The optimal pharmacological treatment of RA-ILD is not sufficiently clarified. The value of methotrexate (MTX) has changed because, in contrast to previous assumptions, a better course could be observed under MTX treatment, at least in mild to moderate courses of RA-ILD. In the case of a clinically relevant RA-ILD, tumor necrosis factor (TNF) blockers should be avoided because a dramatic deterioration of pulmonary function has sometimes been observed. Among biological disease-modifying antirheumatic drugs (DMARD), rituximab and abatacept are currently preferred. The role of Janus kinase (JAK) inhibitors in RA-ILD is currently being discussed but limited data are available. Patients with RA-ILD benefit from a close collaboration between pulmonologists and rheumatologists.
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Affiliation(s)
- A Krause
- Klinik für Innere Medizin, Abteilung Rheumatologie, klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin, Königstr. 63, 14109, Berlin, Deutschland.
| | - A Rubbert-Roth
- Klinik für Rheumatologie, Kantonsspital St. Gallen, St. Gallen, Schweiz
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Paulin F, Doyle TJ, Mercado JF, Fassola L, Fernández M, Caro F, Alberti ML, Espíndola MEC, Buschiazzo E. Development of a risk indicator score for the identification of interstitial lung disease in patients with rheumatoid arthritis. ACTA ACUST UNITED AC 2019; 17:207-211. [PMID: 31420237 DOI: 10.1016/j.reuma.2019.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/17/2019] [Accepted: 05/30/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Clinically evident interstitial lung disease (ILD) affects 10%-42% of RA patients with prognostic implications. The aim of this study was to discern which factors are associated with the presence of ILD in RA patients and to develop a score that could help to stratify the risk of having ILD in RA patients. METHODS Case-control study. We included RA patients recruited from ILD and rheumatology clinics. We retrieved the following data: gender, age, presence of extra articular manifestations, disease activity scores, antibodies status, ESR, and medication use. Multivariate logistic regression was performed. A risk indicator score was developed. RESULTS Of 118 patients included in this study, 52 (44%) had RA-ILD (cases) and 66 (56%) had RA without ILD (controls). Twenty-six patients were male (22%), the mean age was 56.6±15.6 years. Five variables were significantly associated with the presence of ILD: male gender, smoking, extraarticular manifestations, a CDAI score>28, and ESR>80mm/h. The AUC of the final model curve was 0.86 (95%CI 0.79-0.92). Two potential cut-off points of the risk indicator score were chosen: a value of 2 points showed a sensitivity of 90.38% and a specificity of 63.64%, while a value of 4 points showed a sensitivity of 51.9% and a specificity of 90.9%. CONCLUSION This study identified risk factors that could help identify which RA patients are at risk of having ILD through the development of a risk indicator score. This score needs to be validated in an independent cohort.
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Affiliation(s)
- Francisco Paulin
- Hospital María Ferrer, Buenos Aires, Argentina; Hospital Juan A. Fernández, Buenos Aires, Argentina.
| | | | | | | | | | - Fabián Caro
- Hospital María Ferrer, Buenos Aires, Argentina
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Huang Y, Lin W, Chen Z, Wang Y, Huang Y, Tu S. Effect of tumor necrosis factor inhibitors on interstitial lung disease in rheumatoid arthritis: angel or demon? DRUG DESIGN DEVELOPMENT AND THERAPY 2019; 13:2111-2125. [PMID: 31308625 PMCID: PMC6616146 DOI: 10.2147/dddt.s204730] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/28/2019] [Indexed: 12/13/2022]
Abstract
Objectives: This study evaluated the correlation between tumor necrosis factor alpha inhibitor (TNF-I) and interstitial lung disease (ILD) in rheumatoid arthritis (RA). We aimed to raise awareness and consummate therapy by summarizing the characteristics of the adverse events of ILD. Methods: A comprehensive search of the PubMed, Embase, Ovid, Cochrane, China National Knowledge Infrastructure, and Wanfang databases was performed from inception to November 2018. Statistical analysis of demographic characteristics, clinical features, and relative risks was performed using Microsoft Excel 2007 and SPSS version 20.0. Results: A total of 7 eligible articles and another 28 case reports were enrolled. The 7 cohort studies demonstrated the tendency that ILD cases might not benefit from TNF-I therapy. TNF-I might be associated with ILD adverse events. The case reports further confirmed these findings, as most (87.5%) of the cases showed that TNF-1 was harmful to patients with ILD and even resulted in a 35% mortality rate. Further investigation revealed that ILD adverse events tended to appear in female patients with a long RA history (p<0.05). The subgroup analysis suggested that early detection and precise treatment are key factors in determining survival or death when an ILD adverse event occurs. A large proportion of ILD adverse events (48.6%) appeared at 2.38±1.03 weeks after the infusion of infliximab. Conclusion: A fresh look at the evidence highlights that TNF-I might be associated with ILD adverse events in RA, which can induce more severe pulmonary symptoms and even result in death. Therefore, more attention should be paid to effective prevention, early diagnosis, and precise management. Notably, further prospective cohort studies are warranted to better interpret the association or causality between TNF-I and ILD.
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Affiliation(s)
- Ying Huang
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Weiji Lin
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Zhe Chen
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yu Wang
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yao Huang
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Shenghao Tu
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Giles JT. Extra-articular Manifestations and Comorbidity in Rheumatoid Arthritis: Potential Impact of Pre-Rheumatoid Arthritis Prevention. Clin Ther 2019; 41:1246-1255. [PMID: 31196641 DOI: 10.1016/j.clinthera.2019.04.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/18/2019] [Accepted: 04/10/2019] [Indexed: 12/17/2022]
Abstract
Rheumatoid arthritis (RA) is associated with a wide variety of extra-articular manifestations and comorbidities, several of which can be organ- or even life-threatening. These extra-articular manifestations and comorbidities can also contribute to the physical disability and psychological morbidity of RA that lead to reduced quality of life, higher direct and indirect costs, and societal burden of the disease. Although the expansion of RA treatment options and adoption of treat-to-target approaches has reduced the incidence and severity of several nonarticular manifestations of RA, such as rheumatoid vasculitis and cardiovascular disease events, this does not seem to be shared by all RA comorbidities. Moreover, a number of highly prevalent and impactful RA-driven comorbidities, such as accelerated atherosclerosis, interstitial lung disease, and sarcopenia, can present clinically in the years before the manifestation of joint pain or observable synovitis. A larger proportion of patients with RA have atherosclerosis, myocardial dysfunction, interstitial lung disease, and sarcopenia that is subclinical in the preclinical and earliest clinical phases of RA, emphasizing the importance of targeting the pre-RA phase for the prevention of comorbidities that are often poorly responsive to treatment once they develop. Herein, we review the potential impact of pre-RA prevention on the incidence and burden of extra-articular manifestations and nonarticular comorbidities.
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Affiliation(s)
- Jon T Giles
- Columbia University, College of Physicians & Surgeons, New York, NY, USA.
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Masuda T, Yoshida A, Ueno F, Hara S, Nabeta H, Umezawa S, Shirai M, Morikawa Y, Morizane T, Endo Y, Hibi T. A Patient with KL-6 Elevation with Anti-TNFα Who Could Receive Long-Term Use without Interstitial Pneumonia after Class Switch of Anti-TNFα. Inflamm Intest Dis 2019; 4:35-40. [PMID: 31172011 DOI: 10.1159/000497778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/07/2019] [Indexed: 02/03/2023] Open
Abstract
A 40-year-old man with refractory ulcerative colitis (UC) was treated with tumor necrosis factor α inhibitor (anti-TNFα), infliximab. One month later, the chest computed tomography and laboratory test showed noninfectious interstitial lung disease (ILD) and elevation of serum Krebs von den Lungen-6 (KL-6). Fortunately, ILD disappeared after the discontinuation with anti-TNFα. Two and a half years after his first UC treatment, he was treated again with another anti-TNFα, adalimumab, for relapse and he had a second ILD. This course suggested anti-TNFα induced ILD. The characteristics of anti-TNFα-induced ILD in inflammatory bowel disease (IBD) are not well understood. We summarized and investigated the characteristics of such patients based on a literature review including 15 cases. It suggested that anti-TNFα-induced ILD in IBD might be rare and tends to have a better outcome compared with ILD in rheumatoid arthritis.
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Affiliation(s)
- Takuya Masuda
- Center for Gastroenterology and Inflammatory Bowel Disease, Ofuna Chuo Hospital, Kamakura, Japan
| | - Atsushi Yoshida
- Center for Gastroenterology and Inflammatory Bowel Disease, Ofuna Chuo Hospital, Kamakura, Japan
| | - Fumiaki Ueno
- Center for Gastroenterology and Inflammatory Bowel Disease, Ofuna Chuo Hospital, Kamakura, Japan
| | - Shintaro Hara
- Center for Gastroenterology and Inflammatory Bowel Disease, Ofuna Chuo Hospital, Kamakura, Japan
| | - Haruaki Nabeta
- Center for Gastroenterology and Inflammatory Bowel Disease, Ofuna Chuo Hospital, Kamakura, Japan
| | - Shotaro Umezawa
- Center for Gastroenterology and Inflammatory Bowel Disease, Ofuna Chuo Hospital, Kamakura, Japan
| | - Mayuki Shirai
- Center for Gastroenterology and Inflammatory Bowel Disease, Ofuna Chuo Hospital, Kamakura, Japan
| | - Yoshihide Morikawa
- Center for Gastroenterology and Inflammatory Bowel Disease, Ofuna Chuo Hospital, Kamakura, Japan
| | - Toshio Morizane
- Center for Gastroenterology and Inflammatory Bowel Disease, Ofuna Chuo Hospital, Kamakura, Japan
| | - Yutaka Endo
- Center for Gastroenterology and Inflammatory Bowel Disease, Ofuna Chuo Hospital, Kamakura, Japan
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato Institute Hospital, Tokyo, Japan
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Ciancio N, Pavone M, Torrisi SE, Vancheri A, Sambataro D, Palmucci S, Vancheri C, Di Marco F, Sambataro G. Contribution of pulmonary function tests (PFTs) to the diagnosis and follow up of connective tissue diseases. Multidiscip Respir Med 2019; 14:17. [PMID: 31114679 PMCID: PMC6518652 DOI: 10.1186/s40248-019-0179-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/15/2019] [Indexed: 12/22/2022] Open
Abstract
Introduction Connective Tissue Diseases (CTDs) are systemic autoimmune conditions characterized by frequent lung involvement. This usually takes the form of Interstitial Lung Disease (ILD), but Obstructive Lung Disease (OLD) and Pulmonary Artery Hypertension (PAH) can also occur. Lung involvement is often severe, representing the first cause of death in CTD. The aim of this study is to highlight the role of Pulmonary Function Tests (PFTs) in the diagnosis and follow up of CTD patients. Main body Rheumatoid Arthritis (RA) showed mainly an ILD with a Usual Interstitial Pneumonia (UIP) pattern in High-Resolution Chest Tomography (HRCT). PFTs are able to highlight a RA-ILD before its clinical onset and to drive follow up of patients with Forced Vital Capacity (FVC) and Carbon Monoxide Diffusing Capacity (DLCO). In the course of Scleroderma Spectrum Disorders (SSDs) and Idiopathic Inflammatory Myopathies (IIMs), DLCO appears to be more sensitive than FVC in highlighting an ILD, but it can be compromised by the presence of PAH. A restrictive respiratory pattern can be present in IIMs and Systemic Lupus Erythematosus due to the inflammatory involvement of respiratory muscles, the presence of fatigue or diaphragm distress. Conclusions The lung should be carefully studied during CTDs. PFTs can represent an important prognostic tool for diagnosis and follow up of RA-ILD, but, on their own, lack sufficient specificity or sensitivity to describe lung involvement in SSDs and IIMs. Several composite indexes potentially able to describe the evolution of lung damage and response to treatment in SSDs are under investigation. Considering the potential severity of these conditions, an HRCT jointly with PFTs should be performed in all new diagnoses of SSDs and IIMs. Moreover, follow up PFTs should be interpreted in the light of the risk factor for respiratory disease related to each disease.
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Affiliation(s)
- Nicola Ciancio
- 1Regional Referral Center for Rare Lung Diseases, A. O. U. "Policlinico-Vittorio Emanuele" Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Respiratory Physiopathology Group. Società Italiana di Pneumologia. Italian Respiratory Society (SIP/IRS), Milan, Italy
| | - Mauro Pavone
- 1Regional Referral Center for Rare Lung Diseases, A. O. U. "Policlinico-Vittorio Emanuele" Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Sebastiano Emanuele Torrisi
- 1Regional Referral Center for Rare Lung Diseases, A. O. U. "Policlinico-Vittorio Emanuele" Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Ada Vancheri
- 1Regional Referral Center for Rare Lung Diseases, A. O. U. "Policlinico-Vittorio Emanuele" Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Domenico Sambataro
- Artroreuma S.R.L. Outpatient Clinic accredited with the Italian National Health System, Corso S. Vito 53, 95030 Mascalucia (CT), Italy
| | - Stefano Palmucci
- 4Department of Medical Surgical Sciences and Advanced Technologies- Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Carlo Vancheri
- 1Regional Referral Center for Rare Lung Diseases, A. O. U. "Policlinico-Vittorio Emanuele" Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Fabiano Di Marco
- 5Department of Health Sciences, Università degli studi di Milano, Head Respiratory Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Gianluca Sambataro
- 1Regional Referral Center for Rare Lung Diseases, A. O. U. "Policlinico-Vittorio Emanuele" Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Artroreuma S.R.L. Outpatient Clinic accredited with the Italian National Health System, Corso S. Vito 53, 95030 Mascalucia (CT), Italy
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