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

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概要

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• 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.

著者

• JOHKOH TAKESHI

  Department of Medical Physics, Osaka University Graduate School of Medicine

• Tateda Kazuhiro

  Department Of Microbiology And Infectious Disease Toho University School Of Medicine

• KAWAI Shinichi

  Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine

• Goto Hajime

  Department of Respiratory Medicine, Kyorin University School of Medicine

• TAKEUCHI Tsutomu

  Division of Particle and Astrophysical Sciences, Nagoya University

• DOHI Makoto

  Department of Allergy and Rheumatology, University of Tokyo Graduate School of Medicine

• Kameda Hideto

  Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Japa

• Tokuda Hitoshi

  Department of Internal Medicine, Social Health Insurance Central General Hospital, Japan

• Sakai Fumikazu

  Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University

• Mori Shunsuke

  Clinical Research Center for Rheumatic Disease and Department of Rheumatology, NHO Kumamoto Saishuns

• Yoshida Yuji

  Division of Rheumatic Diseases, National Center for Global Health and Medicine, Japan

• Takayanagi Noboru

  Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan

• Taki Hirofumi

  The First Department of Internal Mediceine, University of Toyama, Japan

• Hasegawa Yoshinori

  Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan

• Hatta Kazuhiro

  Department of General Internal Medicine, Tenri Hospital, Japan

• Yamanaka Hisashi

  Institute of Rheumatology, Tokyo Womens Medical University, Japan

• Hashimoto Shu

  Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medici

• Yamada Hidehiro

  Division of Rheumatology and Allergy, Department of Medicine, St. Marianna University School of Medi

• Mori Shunsuke

  Clinical Research Center For Rheumatic Disease And Department Of Rheumatology Kumamoto Saishunsou Na

• Tokuda Hitoshi

  Department Of Internal Medicine Social Insurance Central General Hospital

• Hatta Kazuhiro

  Department Of Comprehensive Care And Education Tenri Hospital

• Takayanagi Noboru

  Department Of Respiratory Medicine Saitama Cardiovascular And Respiratory Center

• Yamanaka Hisashi

  Institute Of Reumatology Tokyo Women's Medical College

• Kameda Hideto

  Division Of Rheumatology And Clinical Immunology Department Of Internal Medicine Faculty Of Medicine

• Hasegawa Yoshinori

  Department Of Biological Mechanisms And Functions Graduate School Of Bioagricultural Sciences Nagoya

• Hashimoto Shu

  Division Of Biological Science Graduate School Of Biology-oriented Science And Technology Kinki Univ

• Dohi Makoto

  Department Of Allergy And Rheumatology Graduate School Of Medicine The University Of Tokyo

• Yoshida Yuji

  Division Of Neonatal Intensive Care Center Of Perinatal Medicine Nara Medical University Hospital

• Takeuchi Tsutomu

  Division Of Particle And Astrophysical Sciences School Of Science Nagoya University

• Yamada Hidehiro

  Division Of Rheumatology And Allergology Department Of Internal Medicine St. Marianna University Sch

• Kawai Shinichi

  Division Of Rheumatology Department Of Internal Medicine (omori) School Of Medicine Faculty Of Medicine

• GOTO HAJIME

  Department of Geriatrics, University of Tokyo Faculty of Medicine

• Kameda Hideto

  Division of Rheumatology, Department of Internal Medicine, School of Medicine, Keio University, Japan

• Kawai Shinichi

  Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, Japan

• Tateda Kazuhiro

  Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Japan

• Yamanaka Hisashi

  Institute of Rheumatology, Tokyo Women's Medical University, Japan

• SAKAI Fumikazu

  Department of Diagnostic Radiology, International Medical Center, Saitama Medical University

• Johkoh Takeshi

  Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine

• Dohi Makoto

  Department of Allergy and Rheumatology, Graduate School of Medicine, University of Tokyo, Japan

• Sakai Fumikazu

  Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, Japan

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