A case of adalimumab-associated interstitial pneumonia with rheumatoid arthritis

Abstract

A 64-year-old woman with rheumatoid arthritis (RA) began to complain of recurrent non-productive cough 5 months after starting adalimumab. The chest radiograph and high-resolution computed tomographic findings revealed diffuse ground-glass attenuation. Her clinical course suggested that interstitial pneumonia (IP) may have been induced by adalimumab, and she was successfully treated with a medium dose of corticosteroid. This case indicates that adalimumab-associated IP should be considered if a RA patient develops non-productive cough following adalimumab therapy.

Adalimumab-induced acute interstitial lung disease in a patient with rheumatoid arthritis

“…( 6 ) Symptoms can appear from one month ( 9 ) to three and a half years after treatment initiation. ( 7 ) Findings on HRCT can include ground-glass opacities, foci of consolidation, reticulated patterns, and traction bronchiectasis.…”

“…( 7 ) Findings on HRCT can include ground-glass opacities, foci of consolidation, reticulated patterns, and traction bronchiectasis. ( 6 , 8 ) …”

“…The course of cases of adalimumab-induced ILD can vary from complete remission after drug discontinuation alone to treatment refractoriness, ( 2 , 6 ) with rapid progression to death. ( 3 ) The use of corticosteroids or intravenous immunoglobulin, or both, should be considered in selected cases.…”

Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2011

“…Case reports of interstitial pneumonia after TNF blocker use continue to appear 510 511. However, in an analysis from a British registry, the mortality of RA patients with ILD following treatment with TNF blockers was not higher than with traditional DMARD therapy (23% vs 21%), despite probable channelling bias toward more use of TNF blockers in those with underlying ILD or organising pneumonia (category C evidence) 512…”

Adalimumab-induced Interstitial Pneumonia with an Improvement of Pre-existing Rheumatoid Arthritis-associated Lung Involvement

“…However, the adverse effects of TNF-α inhibitors include opportunistic infections, liver injury, and drug-associated interstitial lung disease. Several reports have so far described TNF-α inhibitors-induced interstitial pneumonia (1)(2)(3)(4)(5). On the other hand, a few reports have suggested that TNF-α inhibitors may be an important therapeutic strategy in the management of RA-associated lung disease (6).…”