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Nies JF, Schneider U, Krusche M. Rare, rarer, lung involvement in adult-onset Still's disease: A mini-review. Front Med (Lausanne) 2022; 9:989777. [PMID: 36186767 PMCID: PMC9522967 DOI: 10.3389/fmed.2022.989777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Adult-onset Still's disease (AOSD) is a polygenic systemic autoinflammatory disease which is associated with increased morbidity and mortality. Pulmonary involvement is a rare, but serious complication of AOSD. As in AOSD, IL-1b, IL-18, and IL-6 dominate the molecular pathogenesis, which mediate a type 1 and type 3 inflammatory signature of the adaptive immune system. This is evidenced by the success of IL-1- and IL-6 inhibition in the management of AOSD. However, anaphylactic reactions to treatment with IL-1- or IL-6-inhibitors is currently being discussed as a potential trigger for lung involvement inf AOSD, while genetic risk factors have also been identified. Clinically, pulmonary involvement in AOSD can manifest in many different forms. Parenchymal inflammation with peripheral consolidations is the most frequent form while PAH is less common, but often very difficult to manage. This mini-review provides an overview of the pathophysiology as well as the clinical presentation and the diagnostic features of pulmonary involvement in AOSD.
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Gerfaud-Valentin M, Cottin V, Jamilloux Y, Hot A, Gaillard-Coadon A, Durieu I, Broussolle C, Iwaz J, Sève P. Parenchymal lung involvement in adult-onset Still disease: A STROBE-compliant case series and literature review. Medicine (Baltimore) 2016; 95:e4258. [PMID: 27472698 PMCID: PMC5265835 DOI: 10.1097/md.0000000000004258] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Parenchymal lung involvement (PLI) in adult-onset Still's disease (AOSD) has seldom, if ever, been studied. We examine here retrospective cohort AOSD cases and present a review of the literature (1971-2014) on AOSD-related PLI cases.Patients with PLI were identified in 57 AOSD cases. For inclusion, the patients had to fulfill Yamaguchi or Fautrel classification criteria, show respiratory symptoms, and have imaging evidence of pulmonary involvement, and data allowing exclusion of infectious, cardiogenic, toxic, or iatrogenic cause of PLI should be available. This AOSD + PLI group was compared with a control group (non-PLI-complicated AOSD cases from the same cohort).AOSD + PLI was found in 3 out of the 57 patients with AOSD (5.3%) and the literature mentioned 27 patients. Among these 30 AOSD + PLI cases, 12 presented an acute respiratory distress syndrome (ARDS) and the remaining 18 another PLI. In the latter, a nonspecific interstitial pneumonia computed tomography pattern prevailed in the lower lobes, pulmonary function tests showed a restrictive lung function, the alveolar differential cell count was neutrophilic in half of the cases, and the histological findings were consistent with bronchiolitis and nonspecific interstitial pneumonia. Corticosteroids were fully efficient in all but 3 patients. Ten out of 12 ARDS cases occurred during the first year of the disease course. All ARDS-complicated AOSD cases received corticosteroids with favorable outcomes in 10 (2 deceased). Most PLIs occurred during the systemic onset of AOSD.PLI may occur in 5% of AOSDs, of which ARDS is the most severe. Very often, corticosteroids are efficient in controlling this complication.
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Affiliation(s)
- Mathieu Gerfaud-Valentin
- Hospices Civils de Lyon, Hôpital Universitaire de la Croix Rousse, Service de Médecine Interne
- Université de Lyon, Lyon
- Université Lyon 1, Villeurbanne
- Correspondence: Mathieu Gerfaud-Valentin, Hospices Civils de Lyon, Hôpital Universitaire de la Croix Rousse, Service de Médecine Interne, 103 Grande Rue de la Croix Rousse, F-69004 Lyon, France (e-mail: )
| | - Vincent Cottin
- Université de Lyon, Lyon
- Université Lyon 1, Villeurbanne
- Hospices civils de Lyon, Hôpital Louis Pradel, Centre national de référence des maladies pulmonaires rares, centre de compétences de l’hypertension pulmonaire, service de pneumologie, Bron
| | - Yvan Jamilloux
- Hospices Civils de Lyon, Hôpital Universitaire de la Croix Rousse, Service de Médecine Interne
- Université de Lyon, Lyon
- Université Lyon 1, Villeurbanne
| | - Arnaud Hot
- Université de Lyon, Lyon
- Université Lyon 1, Villeurbanne
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service de Médecine Interne, Lyon
| | - Agathe Gaillard-Coadon
- Hospices Civils de Lyon, Hôpital Universitaire de la Croix Rousse, Service de Médecine Interne
- Université de Lyon, Lyon
- Université Lyon 1, Villeurbanne
| | - Isabelle Durieu
- Université de Lyon, Lyon
- Université Lyon 1, Villeurbanne
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service de Médecine Interne, Pierre-Bénite
| | - Christiane Broussolle
- Hospices Civils de Lyon, Hôpital Universitaire de la Croix Rousse, Service de Médecine Interne
- Université de Lyon, Lyon
- Université Lyon 1, Villeurbanne
| | - Jean Iwaz
- Université de Lyon, Lyon
- Université Lyon 1, Villeurbanne
- Hospices Civils de Lyon, Service de Biostatistique, Lyon
- CNRS UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Équipe Biostatistique Santé, Pierre-Bénite, France
| | - Pascal Sève
- Hospices Civils de Lyon, Hôpital Universitaire de la Croix Rousse, Service de Médecine Interne
- Université de Lyon, Lyon
- Université Lyon 1, Villeurbanne
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Abstract
OBJECTIVES To describe the clinical and laboratory features of rheumatoid pleural effusion (RPE) and the diagnostic and therapeutic approaches to this condition. METHODS The review is based on a MEDLINE (PubMed) search of the English literature from 1964 to 2005, using the keywords "rheumatoid arthritis" (RA), "pulmonary complication", "pleural effusion", and "empyema". RESULTS Pleural effusion is common in middle-aged men with RA and positive rheumatoid factor (RF). It has features of an exudate and a high RF titer. Underlying lung pathology is common. Generally RPE is small and resolves spontaneously but symptomatic RPE may require thoracocentesis. Rarely, RPE has features of a sterile empyematous exudate with high lipids and lactate dehydrogenase, and very low glucose and pH levels. This type of effusion eventually leads to fibrothorax and lung restriction. Superimposed infective empyema often complicates RPE. Oral, parenteral, and intrapleural corticosteroids, pleurodesis and decortication, have been used for the treatment of sterile RPE. Infected empyema is treated with drainage and antibiotics. CONCLUSIONS RPE may evolve into a sterile empyematous exudate with the development of fibrothorax. Symptomatic effusions or suspicion of other causes of exudate (infection, malignancy) require thoracocentesis. The "rheumatoid" nature of the pleural exudate in patients without arthritis mandates a pleural biopsy to exclude tuberculosis or malignancy. The optimal therapy of RPE has yet to be established. The role of cytokines in the course of RPE and the possible usefulness of cytokine blockade in the treatment of this RA complication require further evaluation.
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