Neuauftreten und/oder Zunahme von Rheumaknoten unter Leflunomidtherapie bei RA-Patienten

Abstract

This is the first description of the development of rheumatoid nodules in 3 rheumatoid arthritis patients following leflunomide therapy. The nodules were localized at typical sites with preference of the extensor side of hands and elbow. One nodule examined histologically revealed the typical architecture of RA nodules. In all 3 patients the time of onset of nodulosis was about 6 months after initiating the leflunomide therapy. In all 3 patients leflunomide was clinically efficacious concerning RA: remission or near remission was achieved. Due to the extent of nodulosis, the leflunomide therapy had to be stopped in 2 patients. Progression and acceleration of nodulosis is well known following MTX therapy in RA patients. It is caused by adenosine A1 receptor promotion of multinucleated giant cell formation by human monocytes. Leflunomide has no known influence on adenosine metabolism, so different pathogenetic mechanisms must be assumed for the induction of nodulosis by leflunomide.

Lung Infections in Systemic Rheumatic Disease: Focus on Opportunistic Infections

“…Rheumatoid nodules, a characteristic lesion frequently founded in patients with longstanding RA, can occur in the lung [29]. Accelerated lung nodulosis is a well-known complication of RA treatment with methotrexate, leflunomide and, possibly, anti-TNF agents [30,31,32]. Lung rheumatoid nodules are most often asymptomatic unless they cavitate or rupture.…”

Very Low Dose Methotrexate-Induced Rheumatoid Nodules Localized in Buttocks and Palmar Aspects of Phalanges:Case Report

“…5,[9][10][11][12][13][14] Alt ho ugh lef lu no mi de which is a di se a se mo difying an tir he u ma tig drug with a si mi lar ef fi cacy to MTX may al so be con si de red, the re are ca se reports abo ut rhe u ma to id no du les oc cu ring du ring lef lu no mi de tre at ment. 15,16 In conc lu si on, MTX-in du ced lar ge no du les may oc cur even with very low do ses of MTX, in aty pi cal lo ca li za ti ons such as but tocks.…”

Nodulose acelerada na artrite reumatóide durante terapia com Leflunomida

“…A paciente apresentava diagnóstico de AR há 12 anos, conforme os critérios do American College of Rheumatology, e desenvolveu como complicação, durante o uso dessa medicação, um quadro de nodulose acelerada, um efeito adverso raro, classicamente descrito em pacientes com AR que fazem uso de MTX (12) . Encontramos na literatura três outros relatos de casos de nodulose na vigência de leflunomida descritos por Braun et al (7) , no ano de 2004, e em 2006, por Rozin et al (8) . Neste último, dois pacientes cursaram com o aparecimento de nódulos pulmonares durante o uso da mesma medicação.…”

“…Têm sido descritos casos de pacientes que desenvolveram ou agravaram a nodulose com uso de azatioprina (4) , ciclosporina A (5) e etanercepte (6) . Mais recentemente, Braun et al, em 2004 (7) , publicaram três casos de pacientes que desenvolveram nódulos subcutâneos na vigência da terapia com leflunomida. Em 2006, Rozin et al (8) relataram sua experiência com dois pacientes, também portadores de AR, que desenvolveram nódulos pulmonares associados à leflunomida.…”