Clinical and radiological features of acute-onset diffuse interstitial lung diseases in patients with rheumatoid arthritis receiving treatment with biological agents

Importance of Pneumocystis pneumonia in Japan revealed by a multicenter study

Hideto Kameda, Hitoshi Tokuda, Fumikazu Sakai, Takeshi Johkoh, Shunsuke Mori, Yuji Yoshida, Noboru Takayanagi, Hirofumi Taki, Yoshinori Hasegawa, Kazuhiro Hatta, Hisashi Yamanaka, Makoto Dohi, Shu Hashimoto, Hidehiro Yamada, Shinichi Kawai, Tsutomu Takeuchi, Kazuhiro Tateda, Hajime Goto

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Objective Acute-onset diffuse interstitial lung disease (AoDILD) in patients with rheumatoid arthritis (RA) has been a serious concern, especially for those under treatment with biological agents which may affect the presentation and outcome of AoDILD, including Pneumocystis pneumonia (PCP). Therefore, we conducted a retrospective, multi-center study of AoDILD in RA patients receiving biological agents. Methods Patients who developed AoDILD while receiving biological agents (infliximab, etanercept, adalimumab and tocilizumab) were enrolled in the study. Definite PCP was defined as patients who showed either P. jirovecii organisms in their respiratory samples by microscopic examination, or positive tests for both P. jirovicii DNA-PCR with respiratory samples and an elevated serum 1,3-β-D-glucan level above the cut-off value. Probable PCP was defined as either a positive test for P. jirovicii PCR or an elevated serum β-D-glucan level. Chest HRCT findings were evaluated and scored by two board-certified radiologists. Results The final diagnoses for 26 patients examined were definite PCP for 13 patients, probable PCP for 11, and methotrexate-associated pneumonitis in 2 patients. Definite and probable PCP cases were clinically indistinguishable. Generalized, diffuse ground-glass opacity (GGO) is the characteristic HRCT finding in patients with definite or probable PCP, which was different from our previous findings in RA patients, mostly without biologics, showing GGO distributed in a panlobular or multilobular manner. The clinical outcome was favorable by treatment with trimethoprim-sulfamethoxazole and glucocorticoids. Conclusion The possibility of PCP should be intensively investigated in RA patients developing AoDILD while receiving biological agents.

Original languageEnglish
Pages (from-to)305-313
Number of pages9
JournalInternal Medicine
Volume50
Issue number4
DOIs
Publication statusPublished - 2011
Externally publishedYes

Fingerprint

Pneumocystis Pneumonia
Interstitial Lung Diseases
Biological Factors
Multicenter Studies
Rheumatoid Arthritis
Japan
Therapeutics
Glass
Polymerase Chain Reaction
Sulfamethoxazole Drug Combination Trimethoprim
Biological Products
Serum
Methotrexate
Glucocorticoids
Pneumonia
Thorax

Keywords

  • β-D-glucan
  • High-resolution computed tomography
  • Pneumocystis pneumonia
  • Rheumatoid arthritis
  • Tumor necrosis factor inhibitor

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Clinical and radiological features of acute-onset diffuse interstitial lung diseases in patients with rheumatoid arthritis receiving treatment with biological agents : Importance of Pneumocystis pneumonia in Japan revealed by a multicenter study. / Kameda, Hideto; Tokuda, Hitoshi; Sakai, Fumikazu; Johkoh, Takeshi; Mori, Shunsuke; Yoshida, Yuji; Takayanagi, Noboru; Taki, Hirofumi; Hasegawa, Yoshinori; Hatta, Kazuhiro; Yamanaka, Hisashi; Dohi, Makoto; Hashimoto, Shu; Yamada, Hidehiro; Kawai, Shinichi; Takeuchi, Tsutomu; Tateda, Kazuhiro; Goto, Hajime.

In: Internal Medicine, Vol. 50, No. 4, 2011, p. 305-313.

Research output: Contribution to journalArticle

Kameda, H, Tokuda, H, Sakai, F, Johkoh, T, Mori, S, Yoshida, Y, Takayanagi, N, Taki, H, Hasegawa, Y, Hatta, K, Yamanaka, H, Dohi, M, Hashimoto, S, Yamada, H, Kawai, S, Takeuchi, T, Tateda, K & Goto, H 2011, 'Clinical and radiological features of acute-onset diffuse interstitial lung diseases in patients with rheumatoid arthritis receiving treatment with biological agents: Importance of Pneumocystis pneumonia in Japan revealed by a multicenter study', Internal Medicine, vol. 50, no. 4, pp. 305-313. https://doi.org/10.2169/internalmedicine.50.4508
Kameda, Hideto ; Tokuda, Hitoshi ; Sakai, Fumikazu ; Johkoh, Takeshi ; Mori, Shunsuke ; Yoshida, Yuji ; Takayanagi, Noboru ; Taki, Hirofumi ; Hasegawa, Yoshinori ; Hatta, Kazuhiro ; Yamanaka, Hisashi ; Dohi, Makoto ; Hashimoto, Shu ; Yamada, Hidehiro ; Kawai, Shinichi ; Takeuchi, Tsutomu ; Tateda, Kazuhiro ; Goto, Hajime. / Clinical and radiological features of acute-onset diffuse interstitial lung diseases in patients with rheumatoid arthritis receiving treatment with biological agents : Importance of Pneumocystis pneumonia in Japan revealed by a multicenter study. In: Internal Medicine. 2011 ; Vol. 50, No. 4. pp. 305-313.
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abstract = "Objective Acute-onset diffuse interstitial lung disease (AoDILD) in patients with rheumatoid arthritis (RA) has been a serious concern, especially for those under treatment with biological agents which may affect the presentation and outcome of AoDILD, including Pneumocystis pneumonia (PCP). Therefore, we conducted a retrospective, multi-center study of AoDILD in RA patients receiving biological agents. Methods Patients who developed AoDILD while receiving biological agents (infliximab, etanercept, adalimumab and tocilizumab) were enrolled in the study. Definite PCP was defined as patients who showed either P. jirovecii organisms in their respiratory samples by microscopic examination, or positive tests for both P. jirovicii DNA-PCR with respiratory samples and an elevated serum 1,3-β-D-glucan level above the cut-off value. Probable PCP was defined as either a positive test for P. jirovicii PCR or an elevated serum β-D-glucan level. Chest HRCT findings were evaluated and scored by two board-certified radiologists. Results The final diagnoses for 26 patients examined were definite PCP for 13 patients, probable PCP for 11, and methotrexate-associated pneumonitis in 2 patients. Definite and probable PCP cases were clinically indistinguishable. Generalized, diffuse ground-glass opacity (GGO) is the characteristic HRCT finding in patients with definite or probable PCP, which was different from our previous findings in RA patients, mostly without biologics, showing GGO distributed in a panlobular or multilobular manner. The clinical outcome was favorable by treatment with trimethoprim-sulfamethoxazole and glucocorticoids. Conclusion The possibility of PCP should be intensively investigated in RA patients developing AoDILD while receiving biological agents.",
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T2 - Importance of Pneumocystis pneumonia in Japan revealed by a multicenter study

AU - Kameda, Hideto

AU - Tokuda, Hitoshi

AU - Sakai, Fumikazu

AU - Johkoh, Takeshi

AU - Mori, Shunsuke

AU - Yoshida, Yuji

AU - Takayanagi, Noboru

AU - Taki, Hirofumi

AU - Hasegawa, Yoshinori

AU - Hatta, Kazuhiro

AU - Yamanaka, Hisashi

AU - Dohi, Makoto

AU - Hashimoto, Shu

AU - Yamada, Hidehiro

AU - Kawai, Shinichi

AU - Takeuchi, Tsutomu

AU - Tateda, Kazuhiro

AU - Goto, Hajime

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N2 - Objective Acute-onset diffuse interstitial lung disease (AoDILD) in patients with rheumatoid arthritis (RA) has been a serious concern, especially for those under treatment with biological agents which may affect the presentation and outcome of AoDILD, including Pneumocystis pneumonia (PCP). Therefore, we conducted a retrospective, multi-center study of AoDILD in RA patients receiving biological agents. Methods Patients who developed AoDILD while receiving biological agents (infliximab, etanercept, adalimumab and tocilizumab) were enrolled in the study. Definite PCP was defined as patients who showed either P. jirovecii organisms in their respiratory samples by microscopic examination, or positive tests for both P. jirovicii DNA-PCR with respiratory samples and an elevated serum 1,3-β-D-glucan level above the cut-off value. Probable PCP was defined as either a positive test for P. jirovicii PCR or an elevated serum β-D-glucan level. Chest HRCT findings were evaluated and scored by two board-certified radiologists. Results The final diagnoses for 26 patients examined were definite PCP for 13 patients, probable PCP for 11, and methotrexate-associated pneumonitis in 2 patients. Definite and probable PCP cases were clinically indistinguishable. Generalized, diffuse ground-glass opacity (GGO) is the characteristic HRCT finding in patients with definite or probable PCP, which was different from our previous findings in RA patients, mostly without biologics, showing GGO distributed in a panlobular or multilobular manner. The clinical outcome was favorable by treatment with trimethoprim-sulfamethoxazole and glucocorticoids. Conclusion The possibility of PCP should be intensively investigated in RA patients developing AoDILD while receiving biological agents.

AB - Objective Acute-onset diffuse interstitial lung disease (AoDILD) in patients with rheumatoid arthritis (RA) has been a serious concern, especially for those under treatment with biological agents which may affect the presentation and outcome of AoDILD, including Pneumocystis pneumonia (PCP). Therefore, we conducted a retrospective, multi-center study of AoDILD in RA patients receiving biological agents. Methods Patients who developed AoDILD while receiving biological agents (infliximab, etanercept, adalimumab and tocilizumab) were enrolled in the study. Definite PCP was defined as patients who showed either P. jirovecii organisms in their respiratory samples by microscopic examination, or positive tests for both P. jirovicii DNA-PCR with respiratory samples and an elevated serum 1,3-β-D-glucan level above the cut-off value. Probable PCP was defined as either a positive test for P. jirovicii PCR or an elevated serum β-D-glucan level. Chest HRCT findings were evaluated and scored by two board-certified radiologists. Results The final diagnoses for 26 patients examined were definite PCP for 13 patients, probable PCP for 11, and methotrexate-associated pneumonitis in 2 patients. Definite and probable PCP cases were clinically indistinguishable. Generalized, diffuse ground-glass opacity (GGO) is the characteristic HRCT finding in patients with definite or probable PCP, which was different from our previous findings in RA patients, mostly without biologics, showing GGO distributed in a panlobular or multilobular manner. The clinical outcome was favorable by treatment with trimethoprim-sulfamethoxazole and glucocorticoids. Conclusion The possibility of PCP should be intensively investigated in RA patients developing AoDILD while receiving biological agents.

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KW - High-resolution computed tomography

KW - Pneumocystis pneumonia

KW - Rheumatoid arthritis

KW - Tumor necrosis factor inhibitor

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