Factors associated with fatal outcome of leflunomide-induced lung injury in Japanese patients with rheumatoid arthritis.

Takeo Sato, Shigeko Inokuma, Akira Sagawa, Takemasa Matsuda, Tamiko Takemura, Takeshi Otsuka, Yukihiko Saeki, Tsutomu Takeuchi, Tetsuji Sawada

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: To elucidate the factors associated with poor prognosis of LEF-induced lung injury in patients with RA. METHODS: The background and clinical and laboratory features of LEF-induced lung injury were examined and compared between patients who died of and who recovered from it. RESULTS: Among 22 patients who developed LEF-induced lung injury, 9 died of and 13 recovered from it. The patients who died tended to have pre-existing interstitial pneumonia (8/9 vs 6/13, P = 0.07). The loading and maintenance doses, serum concentration of the LEF metabolite A771726 and administration period did not differ between the groups. Patients who died had more frequently hypoxaemia of <60 Torr and mechanical ventilation, and had a high serum CRP level (19.3 +/- 9.4 vs 10.1 +/- 8.1 mg/dl, P = 0.03) and a low albumin level (2.7 +/- 0.6 vs 3.3 +/- 0.5 g/dl, P = 0.03) at the lung injury onset. The peripheral blood lymphocyte count decreased in both groups at the lung injury onset, and it remained low until fatal outcome, in contrast to a re-increase upon recovery (406 +/- 394 vs 1203 +/- 399/microl, P = 0.006). The main histopathological finding in two autopsied patients was diffuse alveolar damage, in contrast to the alveolitis observed in a biopsied patient who recovered. CONCLUSIONS: Pre-existing interstitial pneumonia, extremely high serum CRP and low albumin levels, severe hypoxaemia and mechanical ventilation indicated poor prognosis. Peripheral blood lymphocytopenia developed in association with lung injury, and a sustained low lymphocyte count indicated a fatal outcome.

Original languageEnglish
Pages (from-to)1265-1268
Number of pages4
JournalRheumatology (Oxford, England)
Volume48
Issue number10
Publication statusPublished - 2009 Oct
Externally publishedYes

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leflunomide
Fatal Outcome
Lung Injury
Rheumatoid Arthritis
Interstitial Lung Diseases
Lymphocyte Count
Artificial Respiration
A 771726
Albumins
Serum
Lymphopenia

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Sato, T., Inokuma, S., Sagawa, A., Matsuda, T., Takemura, T., Otsuka, T., ... Sawada, T. (2009). Factors associated with fatal outcome of leflunomide-induced lung injury in Japanese patients with rheumatoid arthritis. Rheumatology (Oxford, England), 48(10), 1265-1268.

Factors associated with fatal outcome of leflunomide-induced lung injury in Japanese patients with rheumatoid arthritis. / Sato, Takeo; Inokuma, Shigeko; Sagawa, Akira; Matsuda, Takemasa; Takemura, Tamiko; Otsuka, Takeshi; Saeki, Yukihiko; Takeuchi, Tsutomu; Sawada, Tetsuji.

In: Rheumatology (Oxford, England), Vol. 48, No. 10, 10.2009, p. 1265-1268.

Research output: Contribution to journalArticle

Sato, T, Inokuma, S, Sagawa, A, Matsuda, T, Takemura, T, Otsuka, T, Saeki, Y, Takeuchi, T & Sawada, T 2009, 'Factors associated with fatal outcome of leflunomide-induced lung injury in Japanese patients with rheumatoid arthritis.', Rheumatology (Oxford, England), vol. 48, no. 10, pp. 1265-1268.
Sato, Takeo ; Inokuma, Shigeko ; Sagawa, Akira ; Matsuda, Takemasa ; Takemura, Tamiko ; Otsuka, Takeshi ; Saeki, Yukihiko ; Takeuchi, Tsutomu ; Sawada, Tetsuji. / Factors associated with fatal outcome of leflunomide-induced lung injury in Japanese patients with rheumatoid arthritis. In: Rheumatology (Oxford, England). 2009 ; Vol. 48, No. 10. pp. 1265-1268.
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AU - Takemura, Tamiko

AU - Otsuka, Takeshi

AU - Saeki, Yukihiko

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AU - Sawada, Tetsuji

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