Radiological features and therapeutic responses of pulmonary nontuberculous mycobacterial disease in rheumatoid arthritis patients receiving biological agents

A retrospective multicenter study in Japan

Shunsuke Mori, Hitoshi Tokuda, Fumikazu Sakai, Takeshi Johkoh, Akio Mimori, Norihiro Nishimoto, Sadatomo Tasaka, Kazuhiro Hatta, Hidekazu Matsushima, Shunji Kaise, Atsushi Kaneko, Shigeki Makino, Seiji Minota, Takashi Yamada, Shinobu Akagawa, Atsuyuki Kurashima

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Objective This study was performed to evaluate the radiological features of and therapeutic responses to pulmonary disease caused by nontuberculous mycobacteria (NTM) in the setting of biological therapy for rheumatoid arthritis (RA). Methods We conducted a retrospective chart review of 13 patients from multiple centers who had developed pulmonary NTM disease during biological therapy for RA, including infliximab, etanercept, adalimumab, and tocilizumab. Results Most cases were asymptomatic or resulted in only common-cold-like symptoms. Abnormalities in computed tomography (CT) imaging were protean and frequently overlapped. The most predominant pattern was nodular/ bronchiectatic disease (six cases), followed by alveolar infiltrate (three cases), cavitary disease (two cases), and pulmonary nodules (two cases). In most cases, pulmonary NTM disease had spread from a preexisting lesion; in particular, bronchial/bronchiolar abnormalities. In three cases, one or more nodular lesions with or without calcification were a focus of disease. Following the discontinuation of biological agents, most patients responded to anti-NTM therapy. Two patients showed no exacerbation in the absence of any anti-NTM therapy. In one patient, restarting tocilizumab therapy while continuing to receive adequate anti-NTM therapy produced a favorable outcome. In two other patients with a previous history of pulmonary NTM disease, introducing biological therapy led to recurrence, but anti-NTM therapy was effective in these patients. Conclusion CT abnormalities of pulmonary NTM disease in RA patients receiving biological therapy were variable, but were not unique to this clinical setting. NTM disease can spread from preexisting structural abnormalities, even if they are minute. Contrary to our expectations, the therapeutic outcomes of pulmonary NTM disease were favorable in these patients.

Original languageEnglish
Pages (from-to)727-737
Number of pages11
JournalModern Rheumatology
Volume22
Issue number5
DOIs
Publication statusPublished - 2012 Sep

Fingerprint

Nontuberculous Mycobacteria
Biological Factors
Multicenter Studies
Rheumatoid Arthritis
Japan
Retrospective Studies
Lung
Biological Therapy
Therapeutics
Tomography
Common Cold
Lung Diseases

Keywords

  • Biological therapy
  • Computed tomography
  • Nontuberculous mycobacteria
  • Pulmonary disease
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Rheumatology

Cite this

Radiological features and therapeutic responses of pulmonary nontuberculous mycobacterial disease in rheumatoid arthritis patients receiving biological agents : A retrospective multicenter study in Japan. / Mori, Shunsuke; Tokuda, Hitoshi; Sakai, Fumikazu; Johkoh, Takeshi; Mimori, Akio; Nishimoto, Norihiro; Tasaka, Sadatomo; Hatta, Kazuhiro; Matsushima, Hidekazu; Kaise, Shunji; Kaneko, Atsushi; Makino, Shigeki; Minota, Seiji; Yamada, Takashi; Akagawa, Shinobu; Kurashima, Atsuyuki.

In: Modern Rheumatology, Vol. 22, No. 5, 09.2012, p. 727-737.

Research output: Contribution to journalArticle

Mori, S, Tokuda, H, Sakai, F, Johkoh, T, Mimori, A, Nishimoto, N, Tasaka, S, Hatta, K, Matsushima, H, Kaise, S, Kaneko, A, Makino, S, Minota, S, Yamada, T, Akagawa, S & Kurashima, A 2012, 'Radiological features and therapeutic responses of pulmonary nontuberculous mycobacterial disease in rheumatoid arthritis patients receiving biological agents: A retrospective multicenter study in Japan', Modern Rheumatology, vol. 22, no. 5, pp. 727-737. https://doi.org/10.1007/s10165-011-0577-6
Mori, Shunsuke ; Tokuda, Hitoshi ; Sakai, Fumikazu ; Johkoh, Takeshi ; Mimori, Akio ; Nishimoto, Norihiro ; Tasaka, Sadatomo ; Hatta, Kazuhiro ; Matsushima, Hidekazu ; Kaise, Shunji ; Kaneko, Atsushi ; Makino, Shigeki ; Minota, Seiji ; Yamada, Takashi ; Akagawa, Shinobu ; Kurashima, Atsuyuki. / Radiological features and therapeutic responses of pulmonary nontuberculous mycobacterial disease in rheumatoid arthritis patients receiving biological agents : A retrospective multicenter study in Japan. In: Modern Rheumatology. 2012 ; Vol. 22, No. 5. pp. 727-737.
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AU - Sakai, Fumikazu

AU - Johkoh, Takeshi

AU - Mimori, Akio

AU - Nishimoto, Norihiro

AU - Tasaka, Sadatomo

AU - Hatta, Kazuhiro

AU - Matsushima, Hidekazu

AU - Kaise, Shunji

AU - Kaneko, Atsushi

AU - Makino, Shigeki

AU - Minota, Seiji

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N2 - Objective This study was performed to evaluate the radiological features of and therapeutic responses to pulmonary disease caused by nontuberculous mycobacteria (NTM) in the setting of biological therapy for rheumatoid arthritis (RA). Methods We conducted a retrospective chart review of 13 patients from multiple centers who had developed pulmonary NTM disease during biological therapy for RA, including infliximab, etanercept, adalimumab, and tocilizumab. Results Most cases were asymptomatic or resulted in only common-cold-like symptoms. Abnormalities in computed tomography (CT) imaging were protean and frequently overlapped. The most predominant pattern was nodular/ bronchiectatic disease (six cases), followed by alveolar infiltrate (three cases), cavitary disease (two cases), and pulmonary nodules (two cases). In most cases, pulmonary NTM disease had spread from a preexisting lesion; in particular, bronchial/bronchiolar abnormalities. In three cases, one or more nodular lesions with or without calcification were a focus of disease. Following the discontinuation of biological agents, most patients responded to anti-NTM therapy. Two patients showed no exacerbation in the absence of any anti-NTM therapy. In one patient, restarting tocilizumab therapy while continuing to receive adequate anti-NTM therapy produced a favorable outcome. In two other patients with a previous history of pulmonary NTM disease, introducing biological therapy led to recurrence, but anti-NTM therapy was effective in these patients. Conclusion CT abnormalities of pulmonary NTM disease in RA patients receiving biological therapy were variable, but were not unique to this clinical setting. NTM disease can spread from preexisting structural abnormalities, even if they are minute. Contrary to our expectations, the therapeutic outcomes of pulmonary NTM disease were favorable in these patients.

AB - Objective This study was performed to evaluate the radiological features of and therapeutic responses to pulmonary disease caused by nontuberculous mycobacteria (NTM) in the setting of biological therapy for rheumatoid arthritis (RA). Methods We conducted a retrospective chart review of 13 patients from multiple centers who had developed pulmonary NTM disease during biological therapy for RA, including infliximab, etanercept, adalimumab, and tocilizumab. Results Most cases were asymptomatic or resulted in only common-cold-like symptoms. Abnormalities in computed tomography (CT) imaging were protean and frequently overlapped. The most predominant pattern was nodular/ bronchiectatic disease (six cases), followed by alveolar infiltrate (three cases), cavitary disease (two cases), and pulmonary nodules (two cases). In most cases, pulmonary NTM disease had spread from a preexisting lesion; in particular, bronchial/bronchiolar abnormalities. In three cases, one or more nodular lesions with or without calcification were a focus of disease. Following the discontinuation of biological agents, most patients responded to anti-NTM therapy. Two patients showed no exacerbation in the absence of any anti-NTM therapy. In one patient, restarting tocilizumab therapy while continuing to receive adequate anti-NTM therapy produced a favorable outcome. In two other patients with a previous history of pulmonary NTM disease, introducing biological therapy led to recurrence, but anti-NTM therapy was effective in these patients. Conclusion CT abnormalities of pulmonary NTM disease in RA patients receiving biological therapy were variable, but were not unique to this clinical setting. NTM disease can spread from preexisting structural abnormalities, even if they are minute. Contrary to our expectations, the therapeutic outcomes of pulmonary NTM disease were favorable in these patients.

KW - Biological therapy

KW - Computed tomography

KW - Nontuberculous mycobacteria

KW - Pulmonary disease

KW - Rheumatoid arthritis

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