title: Tacrolimus-induced pulmonary injury in rheumatoid arthritis patients.
abstract: BACKGROUND
  Tacrolimus (TAC) was approved in Japan in 2005 for rheumatoid arthritis (RA) patients having inadequate response to other disease-modifying anti-rheumatic drugs. As of May 2007, spontaneous reports identified twenty-seven cases of exacerbation or new development of interstitial pneumonia among RA patients given TAC in Japan.
  
  
  OBJECTIVE
  To describe the clinical and radiological characteristics of TAC-induced pulmonary injury (TIPI).
  
  
  METHODS
  Eleven RA patients diagnosed with de novo pulmonary injury or exacerbation of IP during treatment with TAC were identified. Clinical, radiological, and laboratory data of ten of these cases were retrospectively analyzed.
  
  
  RESULTS
  Baseline data for the ten patients were a mean age of 69.7 years; gender, 70% female; mean RA disease duration, 9.1 years; and pulmonary comorbidities, 90%. Six cases were classified as presumptive TAC-induced pulmonary injury (TIPI) and four as probable TIPI. Among the six presumptive cases, TIPI developed at an average of 84 days after initiation of treatment (n = 5) or four days after reinstitution of TAC (n = 1). Five cases were an exacerbation of pre-existing interstitial pneumonia and one was a de novo pulmonary injury. Radiological patterns of thoracic computed tomography (CT) scans of patients in the presumptive TIPI cases were hypersensitivity pneumonia like-pattern (n = 3), ground-glass opacity (n = 2), and organizing pneumonia-pattern (n = 1). All patients with presumptive TIPI were treated with high dosage glucocorticosteroids and one received concomitant immunosuppressants. Two of the six presumptive TIPI patients died.
  
  
  CONCLUSIONS
  Rheumatologists should be aware of this rare but potentially life-threatening adverse event in RA patients receiving TAC.
authors.affiliation: Tokyo Medical and Dental University, Tokyo, Japan. koike.rheu@tmd.ac.jp
authors.forename: Ryuji
authors.initials: R
authors.lastname: Koike
authors.forename: Michi
authors.initials: M
authors.lastname: Tanaka
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Komano
authors.forename: Fumikazu
authors.initials: F
authors.lastname: Sakai
authors.forename: Haruhito
authors.initials: H
authors.lastname: Sugiyama
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Nanki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ide
authors.forename: Satoshi
authors.initials: S
authors.lastname: Jodo
authors.forename: Kou
authors.initials: K
authors.lastname: Katayama
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Matsushima
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Miwa
authors.forename: Koichi
authors.initials: K
authors.lastname: Morita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakashima
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakamura
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Natsumeda
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Sato
authors.forename: Seitaro
authors.initials: S
authors.lastname: Semba
authors.forename: Mutsuto
authors.initials: M
authors.lastname: Tateishi
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Miyasaka
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Harigai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008168:Lung / Q000187:drug effects* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D016559:Tacrolimus / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus