title: Efficacy of intensive immunosuppression in exacerbated rheumatoid arthritis-associated interstitial lung disease.
abstract: OBJECTIVE
  Acute or subacute exacerbations are recognized as a severe complication of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Nevertheless, the role of intensive immunosuppression in RA-ILD remains elusive. We attempted to evaluate the clinical characteristics and efficacy of immunosuppressive treatment in exacerbated RA-ILD.
  
  
  METHODS
  Clinical data, including respiratory function, imaging, treatment, and prognosis, were retrospectively collected for 17 patients with RA-ILD who required hospitalization at the University of Tokyo Hospital due to an acute exacerbation (12 patients) or subacute exacerbation (5 patients).
  
  
  RESULTS
  Patients with RA-ILD demonstrated a significantly higher titers of anticyclic citrullinated peptide antibodies compared with RA patients in Japanese Ninja registry, suggesting the role of adaptive immunity. Immunosuppressive treatment suppressed the deterioration of pulmonary functions with improved ground grass opacity and consolidation. In particular, in patients with less fibrosis on computed tomography (CT) images showed a better response to treatment. Although five patients treated with combination therapy, including cyclophosphamide, showed a severely decreased lung volume, these intensive therapies provided a good prognosis without fatalities for the average observation period of 474 days.
  
  
  CONCLUSIONS
  Immunosuppressive therapy is effective for exacerbations of RA-ILD. For severe cases with low respiratory function, intensive therapy, including cyclophosphamide, has a potential to improve the prognosis.
authors.affiliation: a Department of Allergy and Rheumatology, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan and.
authors.forename: Mineto
authors.initials: M
authors.lastname: Ota
authors.affiliation: a Department of Allergy and Rheumatology, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan and.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Iwasaki
authors.affiliation: a Department of Allergy and Rheumatology, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan and.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Harada
authors.affiliation: a Department of Allergy and Rheumatology, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan and.
authors.forename: Oh
authors.initials: O
authors.lastname: Sasaki
authors.affiliation: a Department of Allergy and Rheumatology, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan and.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Nagafuchi
authors.affiliation: a Department of Allergy and Rheumatology, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan and.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Nakachi
authors.affiliation: a Department of Allergy and Rheumatology, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan and.
authors.forename: Shuji
authors.initials: S
authors.lastname: Sumitomo
authors.affiliation: a Department of Allergy and Rheumatology, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan and.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Shoda
authors.affiliation: b Clinical Research Center for Allergy and Rheumatology , Sagamihara Hospital, National Hospital Organization , Kanagawa , Japan.
authors.forename: Shigeto
authors.initials: S
authors.lastname: Tohma
authors.affiliation: a Department of Allergy and Rheumatology, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan and.
authors.forename: Keishi
authors.initials: K
authors.lastname: Fujio
authors.affiliation: a Department of Allergy and Rheumatology, Graduate School of Medicine , The University of Tokyo , Tokyo , Japan and.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000276:immunology; D001323:Autoantibodies / Q000097:blood; D003520:Cyclophosphamide / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007564:Japan; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology; D017563:Lung Diseases, Interstitial / Q000209:etiology / Q000276:immunology / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology*; D011379:Prognosis; D012129:Respiratory Function Tests / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D001323:Autoantibodies; D007166:Immunosuppressive Agents; D010456:Peptides, Cyclic; D003520:Cyclophosphamide
keywords: Anticyclic-citrullinated antibodies; Cyclophosphamide; Exacerbation; Interstitial lung disease; Rheumatoid arthritis