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

研究成果: Article査読

60 被引用数 (Scopus)

抄録

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.

本文言語English
ページ(範囲)305-313
ページ数9
ジャーナルInternal Medicine
50
4
DOI
出版ステータスPublished - 2011
外部発表はい

ASJC Scopus subject areas

  • 内科学

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