A Case of Steroid-Responsive Organizing Pneumonia in a Patient With Rheumatoid Arthritis Showing Migratory Inhltration and Normal Glucose Levels in Pleural Effusions

Miyagawa, Yosuke; Nagata, Nobuhiko; Nakanishi, Yoichi; Aizawa, Hisamichi; Satake, Marie; Hayashi, Shinichiro; Yagawa, Y.

doi:10.1093/rheumatology/32.9.829

Cited by 7 publications

(4 citation statements)

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“…Her disease was active and RF titers were relatively high at onset. For further understanding of RA-OP, we reviewed 25 cases in the literature from 1987 through 2006 [8,[11][12][13][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] and summarized the clinical features in Table 1, including RF titers, RA duration, treatments for RA and OP, and clinical outcomes. Some cases were excluded because information about RF titers or other disease activity parameters was not provided.…”

Section: Discussionmentioning

confidence: 99%

A simultaneous onset of organizing pneumonia and rheumatoid arthritis, along with a review of the literature

Mori¹,

Cho

Koga

et al. 2007

Mod Rheumatol

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Organizing pneumonia (OP) is a specific type of interstitial pneumonia that has been noted as one of the pulmonary manifestations during the course of rheumatoid arthritis (RA). In this study, we report a case with a simultaneous development of OP and RA. The patient presented with concurrent flu-like symptoms and arthralgia of multiple joints, and antibiotic therapy was not effective. The rheumatoid factor (RF) and anti-cyclic citrullinated antibodies were both high. Multiple air-space opacities on chest radiographs and bilateral peripheral consolidations on high-resolution computed tomography films were evident. The histology of transbronchial lung biopsy samples was characterized by intra-alveolar buds of granulation tissue consisting of intermixed myofibroblasts and connective tissues. Treatment with prednisolone induced a complete recovery from OP without relapses. Our review of previous reports about RA-associated OP (RA-OP) suggested that the high titer of RF and increased disease activity of RA indicate a great risk of developing OP. This condition may represent a lung's reaction in the RA-associated inflammatory and/or immune process. We should be aware of RA-OP cases in which pulmonary manifestations precede articular symptoms. In these cases, respiratory manifestations are the main evidence of RA activity. In most cases of steroid-resistant RA-OP, the use of immunosuppressants was effective. Since OP may progress to fibrotic lung disease during the course of RA, we may consider performing a second lung biopsy for steroid-resistant patients, even if they have once been diagnosed as OP.

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Section: Discussionmentioning

confidence: 99%

A simultaneous onset of organizing pneumonia and rheumatoid arthritis, along with a review of the literature

Mori¹,

Cho

Koga

et al. 2007

Mod Rheumatol

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“…We found 20 cases of OP in which RA patients developed OP during the follow-ups. 31,33,49-64 In all patients except two (cases 35 and 44), for whom data are available, RF was positive at the onset of OP, and in most cases, the titers were high. In cases 29 and 32, seroconversion for RF was observed at the OP onset.…”

Section: Onset Ra Disease Activity Serum Levels Of Anti-ccp Abs Andmentioning

confidence: 94%

“… 15 , 83 Such lesions are nonsegmental 86 and often migrate spontaneously during the course of the disease. 13 , 56 , 87 – 89 …”

Section: Pathological and Clinicoradiological Features Of Opmentioning

confidence: 99%

Organizing Pneumonia in Rheumatoid Arthritis Patients: A Case-Based Review

Mori¹,

Koga²,

Sugimoto

2015

Clin Med Insights Circ Respir Pulm Med

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We treated 21 patients with organizing pneumonia (OP) associated with rheumatoid arthritis (RA) or related to biological disease-modifying antirheumatic drugs (DMARDs) at our institution between 2006 and 2014. Among these cases, 3 (14.3%) preceded articular symptoms of RA, 4 (19.0%) developed simultaneously with RA onset, and 14 (66.7%) occurred during follow-up periods for RA. In the case of OP preceding RA, increased levels of anti-cyclic citrullinated peptide antibodies and rheumatoid factor were observed at the OP onset. RA disease activity was related to the development of OP in the simultaneous cases. In the cases of OP developing after RA diagnosis, 10 of 14 patients had maintained low disease activity with biological DMARD therapy at the OP onset, and among them, 6 patients developed OP within the first year of this therapy. In the remaining four patients, RA activity was not controlled at the OP onset. All patients responded well to systemic steroid therapy, but two patients suffered from relapses of articular and pulmonary symptoms upon steroid tapering. In most of the RA patients, DMARD therapy was introduced or restarted during the steroid tapering. We successfully restarted a biological DMARD that had not been previously used for patients whose RA would otherwise have been difficult to control. In this study, we also perform a review of the literature on RA-associated or biological DMARD-related OP and discuss the pathogenesis and management of OP occurring in RA patients.

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“…Although this therapy has been hinted to slow the progression of RA-related pulmonary fibrosis (73), it has also been associated with the development of fulminate respiratory failure (74). In several case reports, corticosteroids have been suggested as a treatment of the RA-ILD characterized by organizing pneumonia pathologic pattern (75,76). Cyclosporine has been used to treat both acute pneumonitis and progressive pulmonary fibrosis with success in individual patients (5,(77)(78)(79).…”

Section: Current Therapies For Ra-ildmentioning

confidence: 99%

Roger S. Mitchell Lecture. Rheumatoid Lung Disease

Brown¹

2007

Proceedings of the American Thoracic Society

185

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Rheumatoid arthritis (RA) is a common, functionally disabling disease with genetic and environmental contributors. It occurs in approximately 1% of the population and adversely affects quality of life, functional status, and survival. Beyond its impact on the joints, pulmonary involvement occurs regularly and is responsible for a significant portion of the morbidity and mortality. Although pulmonary infection and/or drug toxicity are frequent complications, lung disease directly associated with the underlying RA is more common. The airways, vasculature, parenchyma, and pleura can all be involved, with variable amounts of pathologic inflammation and fibrosis. The true adverse clinical impact of the most important of these directly associated disorders, RA-associated interstitial lung disease (RA-ILD), has only recently begun to reveal itself. Our knowledge of the underlying pathobiology and the impact of our current immunomodulatory and biologic therapies on the lung disease are less than incomplete. However, what is clear is the importance of progressive lung fibrosis in shortening survival and impairing quality of life in RA as well as in other connective tissue diseases. The impact of historically available and newer biologic therapies in altering the outcome of RA-ILD is unknown; translational studies focused on the pathobiology and clinical studies focused on the treatment of RA-ILD are needed.

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A Case of Steroid-Responsive Organizing Pneumonia in a Patient With Rheumatoid Arthritis Showing Migratory Inhltration and Normal Glucose Levels in Pleural Effusions

Cited by 7 publications

References 0 publications

A simultaneous onset of organizing pneumonia and rheumatoid arthritis, along with a review of the literature

A simultaneous onset of organizing pneumonia and rheumatoid arthritis, along with a review of the literature

Organizing Pneumonia in Rheumatoid Arthritis Patients: A Case-Based Review

Roger S. Mitchell Lecture. Rheumatoid Lung Disease

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