著者

Shuntaro Saito Tsutomu Takeuchi

出版者

The Japanese Society for Lymphoreticular Tissue Research

雑誌

Journal of Clinical and Experimental Hematopathology (ISSN:13464280)

巻号頁・発行日

vol.59, no.4, pp.145-155, 2019 (Released:2019-12-22)

参考文献数

108

被引用文献数

13 19

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Methotrexate (MTX) is known as a first-line synthetic disease-modifying anti-rheumatic drug (DMARD) for the treatment of rheumatoid arthritis (RA). Although the risk of LPD development increases by RA inflammation itself, observation of spontaneous regression of LPD after MTX discontinuation lead to the theory of lymphomagenic role of MTX. In this review, we focused on the several immune response involved in LPD that developed under MTX administration in RA patients.

著者

Hideto Kameda Hitoshi Tokuda Fumikazu Sakai Takeshi Johkoh Shunsuke Mori Yuji Yoshida Noboru Takayanagi Hirofumi Taki Yoshinori Hasegawa Kazuhiro Hatta Hisashi Yamanaka Makoto Dohi Shu Hashimoto Hidehiro Yamada Shinichi Kawai Tsutomu Takeuchi Kazuhiro Tateda Hajime Goto

出版者

The Japanese Society of Internal Medicine

雑誌

Internal Medicine (ISSN:09182918)

巻号頁・発行日

vol.50, no.4, pp.305-313, 2011 (Released:2011-02-15)

参考文献数

25

被引用文献数

27 60

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Objective Acute-onset diffuse interstitial lung disease (AoDILD) in patients with rheumatoid arthritis (RA) has been a serious concern, especially for those under treatment with biological agents which may affect the presentation and outcome of AoDILD, including Pneumocystis pneumonia (PCP). Therefore, we conducted a retrospective, multi-center study of AoDILD in RA patients receiving biological agents. Methods Patients who developed AoDILD while receiving biological agents (infliximab, etanercept, adalimumab and tocilizumab) were enrolled in the study. Definite PCP was defined as patients who showed either P. jirovecii organisms in their respiratory samples by microscopic examination, or positive tests for both P. jirovicii DNA-PCR with respiratory samples and an elevated serum 1,3-β-D-glucan level above the cut-off value. Probable PCP was defined as either a positive test for P. jirovicii PCR or an elevated serum β-D-glucan level. Chest HRCT findings were evaluated and scored by two board-certified radiologists. Results The final diagnoses for 26 patients examined were definite PCP for 13 patients, probable PCP for 11, and methotrexate-associated pneumonitis in 2 patients. Definite and probable PCP cases were clinically indistinguishable. Generalized, diffuse ground-glass opacity (GGO) is the characteristic HRCT finding in patients with definite or probable PCP, which was different from our previous findings in RA patients, mostly without biologics, showing GGO distributed in a panlobular or multilobular manner. The clinical outcome was favorable by treatment with trimethoprim-sulfamethoxazole and glucocorticoids. Conclusion The possibility of PCP should be intensively investigated in RA patients developing AoDILD while receiving biological agents.