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Rheumatoid arthritis with pulmonary accelerated rheumatoid nodules treated by baricitinib: a case-based review

  • CASE BASED REVIEW
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Abstract

Pulmonary accelerated rheumatoid nodules (ARN) represent a rare occurrence within the context of rheumatoid arthritis (RA), with conventional treatment typically involving corticosteroids. In this report, we present a unique case of pulmonary ARN managed with baricitinib, a Janus kinase inhibitor. The patient, a 46-year-old woman diagnosed with RA, initially displayed no evident pulmonary nodules upon pulmonary imaging. Her treatment regimen encompassed corticosteroids, methotrexate, and leflunomide. Nevertheless, a chest computed tomography (CT) scan conducted after a year unveiled the presence of multiple bilateral pulmonary nodules. A thoracoscopic biopsy of these nodules confirmed the presence of rheumatoid nodules. Treatment with baricitinib, a Janus kinase inhibitor or synthetic disease-modifying antirheumatic drug (DMARD), effectively reduced the size of the nodules. Our review of 45 articles on ARN published since 1986 found that nine of them reported 13 cases of pulmonary ARN. These nodules may be caused by certain synthetic and biological DMARDs and often present with respiratory symptoms. CT scans typically reveal multiple solid nodules or ground-glass opacities, some of which may have cavities. Treatment customarily involves discontinuing the suspected drugs and administering corticosteroids. This case suggests that Janus kinase inhibitors may be an effective treatment option for ARN.

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Funding

This study was supported by grants from Guangzhou Science and Technology Plan Project (202201010861) and Panyu District Science and Technology Plan Project (2022-Z04-029).

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Author notes

  1. Haijun Liu, Qianhua Li and Kangxia Long contributed equally to this work.

Authors and Affiliations

  1. Department of Rheumatology, Panyu Central Hospital, Guangzhou, China

    Haijun Liu, Kangxia Long & Ouyang Xia

  2. Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang West Road, Guangzhou, China

    Qianhua Li & Lie Dai

  3. Department of Radiology, Panyu Central Hospital, Guangzhou, China

    Yufeng Ye

  4. Department of Pathology, Panyu Central Hospital, Guangzhou, China

    Hao Wang

Authors
  1. Haijun Liu
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Contributions

Haijun Liu, Qianhua Li and Lie Dai were substantially involved in the design of the study and critical revision of the paper for important intellectual content. Haijun Liu, Qianhua Li, and Kangxia Long were substantially involved in drafting the article. All authors were substantially involved in data acquisition, data analysis, and interpretation of data. All authors approved this final version of the article.

Corresponding author

Correspondence to Lie Dai.

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The authors have obtained consent from the patient for the publication of this case study along with any relevant clinical images. All co-authors take full responsibility for the integrity and accuracy of all aspects of the work.

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Liu, H., Li, Q., Long, K. et al. Rheumatoid arthritis with pulmonary accelerated rheumatoid nodules treated by baricitinib: a case-based review. Clin Rheumatol 43, 775–784 (2024). https://doi.org/10.1007/s10067-023-06773-8

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  • DOI: https://doi.org/10.1007/s10067-023-06773-8

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