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Friedlander HM, Ford JA, Zaccardelli A, Terrio AV, Cho MH, Sparks JA. Obstructive lung diseases and risk of rheumatoid arthritis. Expert Rev Clin Immunol 2020; 16:37-50. [PMID: 31774329 DOI: 10.1080/1744666x.2019.1698293] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: Smoking is an established risk factor for both lung diseases and rheumatoid arthritis (RA). Chronic mucosal airway inflammation may result in immune tolerance loss, neoantigen formation, and production of RA-related autoantibodies that increase the subsequent risk of RA. In this review, we aimed to summarize the current evidence supporting the role of obstructive lung diseases and subsequent risk of RA.Areas covered: We identified scientific articles discussing the biologic mechanisms linking mucosal airway inflammation and RA risk. We also identified studies investigating asthma, chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis, chronic tuberculous and nontuberculous mycobacterial infections, and interstitial lung disease with subsequent risk for RA.Expert opinion: The current evidence supports the hypothesis that mucosal airway inflammation may increase the risk of developing RA. However, most studies investigating this relationship have been retrospective and may not have adequately addressed the role of smoking. Larger prospective studies may provide stronger evidence for obstructive lung disease and RA risk. Determining the role of obstructive lung disease in RA pathogenesis may provide opportunity for RA prevention and screening strategies, while identifying novel biologic mechanisms that could offer targets to improve treatment and outcomes.
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Affiliation(s)
- H Maura Friedlander
- Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA
| | - Julia A Ford
- Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Alessandra Zaccardelli
- Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA
| | - Alexsandra V Terrio
- Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA
| | - Michael H Cho
- Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Division of Pulmonary and Critical Care Medicine, Boston, MA, USA.,Brigham and Women's Hospital, Channing Division of Network Medicine, Boston, MA, USA
| | - Jeffrey A Sparks
- Brigham and Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Lim JU, Kang HS, Kim YH, Kim TJ. Amyopathic Dermatomyositis Associated with Histopathological Findings of Organizing Pneumonia and Pulmonary Vasculitis. Balkan Med J 2017; 34:374-377. [PMID: 28443580 PMCID: PMC5615972 DOI: 10.4274/balkanmedj.2016.1061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Clinically, amyopathic dermatomyositis is a clinically distinct subgroup of dermatomyositis characterised by unique dermatological manifestations without muscle involvement. Clinically, amyopathic dermatomyositis is frequently associated with interstitial lung disease, which usually has a rapidly progressive, fatal clinical course. Although clinically, amyopathic dermatomyositis-related interstitial lung disease is well described, data on the histopathology of clinically, amyopathic dermatomyositis-interstitial lung disease are limited. Organising pneumonia and pulmonary vasculitis have rarely been reported. Case Report: A 54-year-old Korean woman presented with exertional dyspnoea and a dry cough. Chest computed tomography revealed subpleural ground-glass opacities suggesting interstitial lung disease, which was later pathologically confirmed to be a combination of organising pneumonia and pulmonary vasculitis. The patient improved markedly with prednisone treatment and has remained stable for a long time. Conclusion: We hereby report a rare combination of organising pneumonia and pulmonary vasculitis in a patient with amyopathic dermatomyositis-interstitial lung disease.
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Affiliation(s)
- Jeong Uk Lim
- Division of Allergy and Pulmonology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, South Korea
| | - Hye Seon Kang
- Division of Allergy and Pulmonology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, South Korea
| | - Yong Hyun Kim
- Division of Allergy and Pulmonology, Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, South Korea
| | - Tae Jung Kim
- Department of Hospital Pathology, The Catholic University of Korea School of Medicine, Seoul, South Korea
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Clinical characteristics of autoimmune rheumatic disease-related organizing pneumonia. Clin Rheumatol 2017; 37:1027-1035. [PMID: 28748510 DOI: 10.1007/s10067-017-3694-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 05/11/2017] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
Abstract
To study the clinical characteristics of autoimmune rheumatic disease-related organizing pneumonia (AIRD-OP), the clinical presentation, radiological findings, treatment, and outcome of AIRD-OP patients were analyzed, in comparison with patients with cryptogenic organizing pneumonia (COP). A total of 131 OP patients were identified, including 57 cases of AIRD-OP, 35 cases of COP, and 39 cases of other disease-related OPs. Among AIRD-OP patients, 36 (63%) presented the symptoms of OP at onset. The primary disease of AIRDs included Sjogren's syndrome (38%), polymyositis/dermatomyositis (23%), rheumatoid arthritis (23%), and undifferentiated AIRD. Compared with COP patients, the prevalence of patients having cough and malaise at baseline was significantly lower (54.4 vs 82.9%, P < 0.05; 49.1 vs 70.6%, P < 0.05), and the signs of moist rales and crackles were more common in AIRD-OP patients (54.4 vs 32.4%, P < 0.05; 49.1 vs 26.5%, P < 0.05). Lung function (TLC%, FVC%) was more significantly reduced in AIRD-OP patients (72 vs 97%, P < 0.05;75 vs 96%, P < 0.05). The dosage of corticosteroids prescribed was significantly higher in AIRD-OP patients (44 vs 37 mg/day, P < 0.05). The complete recovery rate was slightly lower in AIRD-OP patients (22.2 vs 29%, P > 0.05) with a tendency towards higher recurrence rate in AIRD-OP patients (32.7 vs 14.3%, P < 0.05). AIRD-OP may be the most common cause of OP. OP can be the initial presentation of AIRD. Compared with COP patients, AIRD-OP patients are characterized with occult onset but more severe lung involvement and higher recurrence rate.
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Okada H, Kurasawa K, Yamazaki R, Tanaka A, Arai S, Owada T, Maezawa R, Ishii Y. Clinical features of organizing pneumonia associated with rheumatoid arthritis. Mod Rheumatol 2016; 26:863-868. [DOI: 10.3109/14397595.2016.1153217] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Harutsugu Okada
- Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi, Japan and
| | - Kazuhiro Kurasawa
- Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi, Japan and
- Center for Rheumatic Diseases, Dokkyo Medical University, Tochigi, Japan
| | - Ryutaro Yamazaki
- Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi, Japan and
| | - Ayae Tanaka
- Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi, Japan and
| | - Satoko Arai
- Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi, Japan and
| | - Takayoshi Owada
- Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi, Japan and
| | - Reika Maezawa
- Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi, Japan and
- Center for Rheumatic Diseases, Dokkyo Medical University, Tochigi, Japan
| | - Yoshiki Ishii
- Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi, Japan and
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Kawasumi H, Gono T, Tanaka E, Kaneko H, Kawaguchi Y, Yamanaka H. Clinical Characteristics and Cytokine Profiles of Organizing Pneumonia in Patients with Rheumatoid Arthritis Treated with or without Biologics. J Rheumatol 2016; 43:738-44. [PMID: 26834212 DOI: 10.3899/jrheum.151019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE It has been reported that organizing pneumonia (OP) develops when patients with rheumatoid arthritis (RA) are treated with biologic disease-modifying antirheumatic drugs (bDMARD). However, the clinical characteristics and pathophysiology of OP in RA remain unknown in patients treated with bDMARD. We investigated the clinical characteristics and cytokine profiles of patients with RA-OP treated with bDMARD or conventional synthetic DMARD (csDMARD). METHODS Twenty-four patients with RA who had developed OP were enrolled. These patients included 12 treated with bDMARD (bDMARD-OP subset) and 12 treated with csDMARD (csDMARD-OP subset). We compared the clinical characteristics and cytokine profiles between the patients with OP (OP subset, n = 24) and non-OP patients (non-OP subset, n = 29). RESULTS There was no significant difference in clinical characteristics between the OP subset and the non-OP subset. Four patients developed OP within 2 months of bDMARD administration. In the other 8 patients, OP developed more than 1 year after the initiation of bDMARD. OP improved with corticosteroid treatment in all bDMARD-OP patients. After OP improved, bDMARD were readministered in 6 patients, and no OP recurrence was observed in any of these patients. Our multivariate analysis revealed that serum levels of interferon-α (IFN-α), interleukin (IL)-1β, IL-6, IL-8, and interferon-γ-inducible protein 10 were significantly associated with the development of OP, although these cytokines tended to be lower in the bDMARD-OP subset than in the csDMARD-OP subset. CONCLUSION OP is unlikely to be fatal in patients treated with bDMARD or csDMARD. IFN-α and proinflammatory cytokines are associated with the pathophysiology of OP in RA.
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Affiliation(s)
- Hidenaga Kawasumi
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University
| | - Takahisa Gono
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University.
| | - Eiichi Tanaka
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University
| | - Hirotaka Kaneko
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University
| | - Yasushi Kawaguchi
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University
| | - Hisashi Yamanaka
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University
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Mori S, Koga Y, Sugimoto M. Organizing Pneumonia in Rheumatoid Arthritis Patients: A Case-Based Review. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2015; 9:69-80. [PMID: 26543387 PMCID: PMC4624096 DOI: 10.4137/ccrpm.s23327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/08/2015] [Accepted: 09/14/2015] [Indexed: 12/29/2022]
Abstract
We treated 21 patients with organizing pneumonia (OP) associated with rheumatoid arthritis (RA) or related to biological disease-modifying antirheumatic drugs (DMARDs) at our institution between 2006 and 2014. Among these cases, 3 (14.3%) preceded articular symptoms of RA, 4 (19.0%) developed simultaneously with RA onset, and 14 (66.7%) occurred during follow-up periods for RA. In the case of OP preceding RA, increased levels of anti-cyclic citrullinated peptide antibodies and rheumatoid factor were observed at the OP onset. RA disease activity was related to the development of OP in the simultaneous cases. In the cases of OP developing after RA diagnosis, 10 of 14 patients had maintained low disease activity with biological DMARD therapy at the OP onset, and among them, 6 patients developed OP within the first year of this therapy. In the remaining four patients, RA activity was not controlled at the OP onset. All patients responded well to systemic steroid therapy, but two patients suffered from relapses of articular and pulmonary symptoms upon steroid tapering. In most of the RA patients, DMARD therapy was introduced or restarted during the steroid tapering. We successfully restarted a biological DMARD that had not been previously used for patients whose RA would otherwise have been difficult to control. In this study, we also perform a review of the literature on RA-associated or biological DMARD-related OP and discuss the pathogenesis and management of OP occurring in RA patients.
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Affiliation(s)
- Shunsuke Mori
- Department of Rheumatology, Clinical Research Center for Rheumatic Diseases, NHO Kumamoto Saishunsou National Hospital, Kumamoto, Japan
| | - Yukinori Koga
- Department of Radiology, Clinical Research Center for Rheumatic Diseases, NHO Kumamoto Saishunsou National Hospital, Kumamoto, Japan
| | - Mineharu Sugimoto
- Division of Respiratory Medicine, Department of Medicine, NHO Kumamoto Saishunsou National Hospital, Kumamoto, Japan
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