Pulmonary Nodulosis and Aseptic Granulomatous Lung Disease Occurring in Patients with Rheumatoid Arthritis Receiving Tumor Necrosis Factor-α-Blocking Agent: A Case Series

• DOI: 10.3899/jrheum.090030
• Publication Date: 2009-10-02T02:01:47Z
• Authors: ERIC TOUSSIROT; JEAN MARIE BERTHELOT; EDOUARD PERTUISET; BÉATRICE BOUVARD; PHILIPPE GAUDIN; DANIEL WENDLING; JOSÉ le NOACH; ANNE LOHSE; EMMANUELLE LECUYER; Le CRI
• Keywords: Rheumatoid nodule; Rheumatoid factor; Discontinuation

Objective. To describe cases of development pulmonary nodulosis or aseptic granulomatous lung disease in patients with rheumatoid arthritis (RA) receiving anti-tumor necrosis factor-α (TNF-α) therapy. Methods. A call for observation such was sent to members the French “Club Rhumatismes et Inflammation.” The had occur after introduction TNF-α-blocking Results. Eleven were examined: 6 treated etanercept, 2 infliximab, and 3 adalimumab. Pulmonary nodular lesions observed a mean treatment period 23.3 ± 15.3 months. Clinical symptoms 5 cases. Radiographs computed tomography chest showed single multiple 10 hilar adenopathies 1 case. Biopsy mediastinal lymphadenopathies performed 8 patients, revealed typical nodules 4 noncaseating Mycobacterial opportunistic infections excluded all Outcome favorable either discontinuation maintenance anti-TNF-α treatment. Conclusion. Aseptic inflammation corresponding can during therapy RA, mainly etanercept. mechanism explaining reaction is not clear but certainly includes different processes. These generally have benign course do systematically require withdrawal