title: Clinical investigation of nontuberculous mycobacterial lung disease in Japanese patients with rheumatoid arthritis receiving biologic therapy.
abstract: OBJECTIVE
  To review patients with rheumatoid arthritis (RA) receiving biologic therapy following a diagnosis of nontuberculous mycobacterial (NTM) lung disease and to evaluate disease deterioration according to clinical and radiological features and anti-NTM therapy.
  
  
  METHODS
  We retrospectively analyzed medical records of 11 human immunodeficiency virus-negative patients with RA (median age, 64 years) receiving biologic therapy following diagnosis of NTM lung disease.
  
  
  RESULTS
  NTM species included Mycobacterium avium complex in 9 patients (81.8%) and M. gordonae in 2 (18.2%). Underlying respiratory disease was present in 6 patients (54.5%), and most (81.8%) had radiographic features of nodular/bronchiectatic disease. Extent of NTM disease was 1-2 pulmonary lobes in 6 patients (54.5%), 3-4 lobes in 5 patients (45.5%), and 5-6 lobes in none. The results of radiological evaluations were unchanged or improved in 7 patients (63.6%) and worsened in 4 (36.4%). Radiological outcome was worse in patients with poor RA control despite their receiving biologic therapies for RA. Two of 3 patients receiving anti-NTM therapy as initial management for NTM improved, and 1 worsened. Three of 4 patients with worsened radiological outcome had high erythrocyte sedimentation rate (> 50 mm/h).
  
  
  CONCLUSIONS
  Radiological deterioration was not observed in the majority of patients with RA receiving biologic therapy with NTM lung disease, and radiological outcome of pulmonary NTM was favorable in some patients undergoing anti-NTM therapy. Further studies focusing on disease deterioration according to biologic therapy received during NTM followup are warranted to determine appropriate treatment of RA patients with NTM lung disease.
authors.affiliation: From the Department of Respiratory Medicine and Department of Radiology, Saitama Cardiovascular and Respiratory Center, Saitama; and the Department of Respiratory Medicine, Tokyo Jikei University Hospital, Tokyo, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Yamakawa
authors.forename: Noboru
authors.initials: N
authors.lastname: Takayanagi
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishiguro
authors.forename: Tetsu
authors.initials: T
authors.lastname: Kanauchi
authors.forename: Toshiko
authors.initials: T
authors.lastname: Hoshi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Sugita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology*; D044466:Asian People; D001685:Biological Factors / Q000008:administration & dosage / Q000009:adverse effects*; D000068800:Etanercept; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host; D007074:Immunoglobulin G / Q000008:administration & dosage / Q000009:adverse effects; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging; D009162:Mycobacterium avium / Q000302:isolation & purification*; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification*; D011859:Radiography; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage; D012189:Retrospective Studies
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D001685:Biological Factors; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000069285:Infliximab; C502936:tocilizumab; D000068800:Etanercept
keywords: BIOLOGIC THERAPY; DRUG TOXICITY; NONTUBERCULOUS MYCOBACTERIAL LUNG DISEASE; RADIOLOGICAL DETERIORATION; RHEUMATOID ARTHRITIS