Adalimumab-Induced Acute Pneumonitis in a Patient With Rheumatoid Arthritis

Dascalu, Cosmin; Mrejen-Shakin, Karen; Bandagi, Sabiha

doi:10.1097/rhu.0b013e3181df8361

Cited by 26 publications

(14 citation statements)

References 10 publications

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“…( 10 ) In addition, an increased Th2-type lymphocyte response, ( 7 ) the action of IFN-γ unopposed by TNF, ( 7 ) and the synergistic action of methotrexate are speculated to play a role in the development of lung injury. ( 8 , 9 , 11 , 12 ) …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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The use of immunobiological agents for the treatment of autoimmune diseases is increasing in medical practice. Anti-TNF therapies have been increasingly used in refractory autoimmune diseases, especially rheumatoid arthritis, with promising results. However, the use of such therapies has been associated with an increased risk of developing other autoimmune diseases. In addition, the use of anti-TNF agents can cause pulmonary complications, such as reactivation of mycobacterial and fungal infections, as well as sarcoidosis and other interstitial lung diseases (ILDs). There is evidence of an association between ILD and the use of anti-TNF agents, etanercept and infliximab in particular. Adalimumab is the newest drug in this class, and some authors have suggested that its use might induce or exacerbate preexisting ILDs. In this study, we report the first case of acute ILD secondary to the use of adalimumab in Brazil, in a patient with rheumatoid arthritis and without a history of ILD.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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“…There are a number of reports of interstitial pneumonia induced by IFN, ETN and adalimumab [63][64][65][66][67][68][69][70]. The incidence of mAbinduced interstitial pneumonia is unknown but, in 2007, Dixon et al studied 9294 RA patients treated with anti-TNF agents and 2454 treated with nonbiological agents in the British Society for Rheumatology Biologics Register, and found a higher prevalence of physician-reported interstitial pneumonia in the former (2.9 vs 1.8%; p = 0.002) [71].…”

Section: Interstitial Pneumoniamentioning

confidence: 99%

Lung involvement and drug-induced lung disease in patients with rheumatoid arthritis

Atzeni¹,

Boiardi

Salli

et al. 2013

Expert Review of Clinical Immunology

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Interstitial lung disease (ILD) is a common extra-articular manifestation of rheumatoid arthritis (RA) and a significant cause of morbidity and mortality. Usual interstitial pneumonia and nonspecific interstitial pneumonia seem to be the most frequent patterns in RA patients with ILD, although the proportion of patients with usual interstitial pneumonia is higher than among patients with other systemic rheumatic autoimmune diseases. RA patients with ILD most frequently present with chronic symptoms of cough and dyspnea when climbing stairs or walking uphill. A physical examination may reveal inhalatory crackles and a pulmonary function test demonstrates restrictive physiology, often with reduced diffusing capacity. High-resolution computed tomography is generally sufficient to confirm a diagnosis of ILD, although a minority of cases may require a surgical lung biopsy. Conventional disease-modifying antirheumatic drugs such as methotrexate (MTX) or leflunomide (LEF) and biological agents such as TNF-blocking agents or rituximab may trigger or aggravate ILD in RA patients, and infections may contribute to increased mortality in such patients. LEF should not be used in patients with a history of MTX pneumonitis. The prevalence of interstitial pneumonia among RA patients treated with anti-TNF agents ranges from 0.5 to 3%; however, as the evidence that anti-TNF increases or decreases the risk of ILD is controversial, it is not clear whether this indicates more severe RA requiring biological therapy or the effect of exposure to potentially toxic drugs such as MTX or LEF. The development of treatment-related ILD is a paradoxical adverse event, and patients should be warned about this rare but serious complication of biological or disease-modifying antirheumatic drug therapy.

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“…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…”

Section: Updatementioning

confidence: 99%

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

Fürst

Keystone

Braun

et al. 2012

Annals of the Rheumatic Diseases

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Adalimumab-Induced Acute Pneumonitis in a Patient With Rheumatoid Arthritis

Cited by 26 publications

References 10 publications

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

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

Lung involvement and drug-induced lung disease in patients with rheumatoid arthritis

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

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