Skip to main content

Advertisement

SpringerLink
Log in

Occurrence of pulmonary rheumatoid nodules following biological therapies

  • Case Based Review
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

In rheumatoid arthritis (RA), disease activity is generally determined by the joint involvement, but the treatment outcome is often influenced by extra-articular manifestations. Authors present a 74-year-old female patient’s case history, who was treated with seropositive RA. Marked disease activity was observed even following combined traditional disease-modifying antirheumatic drug (DMARD) treatment (disease activity score in 28 joints (DAS28) = 6.6). Therefore, the patient received TNF-α antagonist therapy. Golimumab was administered subcutaneous (SC) once monthly which resulted in significant improvement in both clinical and laboratory signs (DAS28 = 3:43). However, the follow-up chest x-ray indicated multiple intrapulmonary foci and enlarged lymph nodes. Biopsies and histology excluded malignancy; rheumatoid nodules were confirmed. Anti-TNF therapy was discontinued and tocilizumab treatment was initiated. The IL-6 receptor inhibitor suppressed arthritic activity, and 2 months later, the follow-up chest x-ray showed a regression of chest nodules. Our cases, as well as reports from other centers, suggest that TNF blockade may induce rheumatoid nodulosis and the use of alternative biologics may be feasible as further treatment of RA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Myasoedova E, Davis JM, Crowson CS, Gabriel SE (2010) Epidemiology of rheumatoid arthritis: rheumatoid arthritis and mortality. Curr Rheumatol Rep 12:379–385

    Article  PubMed  Google Scholar 

  2. Kerstens P, Boerbooms AM, Jeurissen ME et al (1992) Accelerated nodulosis during low dose methotrexate therapy for rheumatoid arthritis; an analysis of ten cases. J Rheumatol 19:867–71

    CAS  PubMed  Google Scholar 

  3. Braun MG, Van Rhee R, Becker-Capeller D (2004) Development and/or increase of rheumatoid nodules in rheumatoid arthritis patients following leflunomide therapy. Rheumatology 63:84–87

    CAS  Google Scholar 

  4. Kekow J, Welte T, Kellner U et al (2002) Development of rheumatoid nodules during anti-ecrosis factor alpha therapy with etanercept. Arthritis Rheum 46:843–844

    Article  PubMed  Google Scholar 

  5. Toussirot E, Berthelot JM, Pertuiset E et al (2009) Pulmonary nodulosis and aseptic granulomatous lung disease occurring in patients with rheumatoid arthritis receiving tumor necrosis factor alpha-blocking agent: a case series. J Rheumatol 36:2421–2427

    Article  PubMed  Google Scholar 

  6. Khurana R, Wolf R, Berney S (2008) Risk of development of lung cancer is increased in patients with rheumatoid arthritis: a large case control study in US veterans. J Rheum 35:1704–1708

    PubMed  Google Scholar 

  7. Smitten AL, Simon TA, Hochberg MC et al (2008) A metaanalysis of the incidence of malignancy in adult patients with rheumatoid arthritis. Arthritis Res Ther 10:R45

    Article  PubMed Central  PubMed  Google Scholar 

  8. Saraya T, Tanaka R, Fujiwara M et al (2013) Fluorodeoxyglucose (FDG) uptake in pulmonary rheumatoid nodules diagnosed by video-assisted thoracic surgery lung biopsy: two case reports and a review of the literature. Mod Rheumatol 23:393–396

    Article  CAS  PubMed  Google Scholar 

  9. Spina D, Ambrosio MR, Rocca BJ et al (2011) Rheumatoid nodule and combined pulmonary carcinoma: topographic correlations; a case report and review of the literature. Histol Histopathol 26:351–356

    PubMed  Google Scholar 

  10. Derot G, Marini-Portugal A, Maitre B et al (2009) Marked regression of pulmonary rheumatoid nodules under etanercept therapy. J Rheumatol 36:437–439

    Article  PubMed  Google Scholar 

  11. Andres M, Vela P, Romera C (2012) Marked improvement of lung rheumatoid nodules after treatment with tocilizumab. Rheumatology 51:1132–1134

    Article  CAS  PubMed  Google Scholar 

  12. Glace B, Gottenberg JE, Mariette X et al (2012) Efficacy of rituximab in the treatment of pulmonary rheumatoid nodules: findings in 10 patients from the French Auto Immunity and Rituximab/Rheumatoid Arthritis registry (AIR/PR registry). Ann Rheum Dis 71:1429–1431

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The work was supported by the European Union and the State of Hungary co-financed by the European Social Fund in the framework of TÁMOP-4.2.4.A/2-11/1-2012-0001 ‘National Excellence Program’ (Z.S.)

Disclosures

None

Author information

Authors and Affiliations

  1. Hospital of Hungarian State Railways, Szolnok, Hungary

    Attila Kovács, Beáta Baksay, Anita Cserenyecz, Klára Molnár & Mária Takács

  2. Department of Rheumatology, Institute of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

    Zoltán Szekanecz

Authors
  1. Attila Kovács
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Beáta Baksay
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anita Cserenyecz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Klára Molnár
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mária Takács
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zoltán Szekanecz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zoltán Szekanecz.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kovács, A., Baksay, B., Cserenyecz, A. et al. Occurrence of pulmonary rheumatoid nodules following biological therapies. Clin Rheumatol 34, 1639–1642 (2015). https://doi.org/10.1007/s10067-014-2789-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-014-2789-6

Keywords

Search

Navigation