title: Occurrence of pulmonary rheumatoid nodules following biological therapies.
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.
authors.affiliation: Hospital of Hungarian State Railways, Szolnok, Hungary.
authors.forename: Attila
authors.initials: A
authors.lastname: Kovács
authors.forename: Beáta
authors.initials: B
authors.lastname: Baksay
authors.forename: Anita
authors.initials: A
authors.lastname: Cserenyecz
authors.forename: Klára
authors.initials: K
authors.lastname: Molnár
authors.forename: Mária
authors.initials: M
authors.lastname: Takács
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Szekanecz
mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy; D001691:Biological Therapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D011859:Radiography; D019947:Receptors, Interleukin-6 / Q000037:antagonists & inhibitors*; D012218:Rheumatoid Nodule / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000009:adverse effects* / Q000037:antagonists & inhibitors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D019947:Receptors, Interleukin-6; D014409:Tumor Necrosis Factor-alpha; C502936:tocilizumab