Radiological features and therapeutic responses of pulmonary nontuberculous mycobacterial disease in rheumatoid arthritis patients receiving biological agents: a retrospective multicenter study in Japan

Abstract

ObjectiveThis study was performed to evaluate the radiological features of and therapeutic responses to pulmonary disease caused by nontuberculous mycobacteria (NTM) in the setting of biological therapy for rheumatoid arthritis (RA).MethodsWe conducted a retrospective chart review of 13 patients from multiple centers who had developed pulmonary NTM disease during biological therapy for RA, including infliximab, etanercept, adalimumab, and tocilizumab.ResultsMost cases were asymptomatic or resulted in only common-cold-like symptoms. Abnormalities in computed tomography (CT) imaging were protean and frequently overlapped. The most predominant pattern was nodular/bronchiectatic disease (six cases), followed by alveolar infiltrate (three cases), cavitary disease (two cases), and pulmonary nodules (two cases). In most cases, pulmonary NTM disease had spread from a preexisting lesion; in particular, bronchial/bronchiolar abnormalities. In three cases, one or more nodular lesions with or without calcification were a focus of disease. Following the discontinuation of biological agents, most patients responded to anti-NTM therapy. Two patients showed no exacerbation in the absence of any anti-NTM therapy. In one patient, restarting tocilizumab therapy while continuing to receive adequate anti-NTM therapy produced a favorable outcome. In two other patients with a previous history of pulmonary NTM disease, introducing biological therapy led to recurrence, but anti-NTM therapy was effective in these patients.ConclusionCT abnormalities of pulmonary NTM disease in RA patients receiving biological therapy were variable, but were not unique to this clinical setting. NTM disease can spread from preexisting structural abnormalities, even if they are minute. Contrary to our expectations, the therapeutic outcomes of pulmonary NTM disease were favorable in these patients.

Mycobacterial diseases developed during anti-tumour necrosis factor-α therapy

“…Similar to the findings of previous studies, our results showed favourable clinical outcomes in patients with NTM disease [19,20]. In addition, the clinical outcomes of NTM patients did not differ significantly compared with those of TB patients.…”

“…In addition, as clinicians are concerned about the development of TB in patients treated with TNF-a inhibitors, there is a focus on screening and treating latent TB infection (LTBI) before administering TNF-a inhibitors. Although reports of NTM lung disease in patients treated with TNF-a antagonists have been published [5,12,19,20], clinical data on NTM lung disease developed during anti-TNF therapy is lacking. Our results indicate that development of NTM lung disease was during anti-TNF-a therapy.…”

<i>Mycobacterium abscessus</i> Pulmonary Infection under Treatment with Tocilizumab

“…It has been reported that the onset of pulmonary NTM disease in RA patients appears to spread from pre-existing lung lesions, such as those involving bronchiectasis or nodules (12). However, it is currently unclear whether these preexisting abnormalities reflect the subclinical presence of pulmonary NTM colonization or constitute an extra-articular manifestation of RA.…”

“…These RA patients included two individuals who had been treated with TNF antagonists (11,12) and two who had not been treated with biological DMARDs (13,14). Two of these four cases were fatal (11,13).…”

Segurança do uso de terapias biológicas para o tratamento de artrite reumatoide e espondiloartrites

“…No Japão, não houve aumento do número de casos de doença por micobactérias não tuberculosas. 205 Evidências recentes não demonstraram aumento da taxa de infecção da ferida operatória em pacientes com AR e em uso de TOCI após realização de artroplastia total de joelho ou quadril. 206 Recomenda-se suspensão do TOCI, pelo menos, quatro semanas antes do procedimento.…”