Tengstrand Birgitta, Ernestam Sofia, Engvall Inga-Lill, Rydvald Ylva, Hafström Ingiäld
Reumatologiska kliniken, Karolinska Universitetssjukhuset Huddinge, SE-141 86 Stockholm, Sweden.
Lakartidningen. 2005;102(49):3788-90, 3793.
TNF-blockade has been increasingly used in the treatment of rheumatoid arthritis (RA). However, the safety is unclear and an increased risk of both tuberculosis and other infections has been identified. Recently severe fibrosing alveolitis has also been reported in RA-patients treated with TNF-blockade. We report a further six RA patients, who during treatment with infliximab or etanercept developed fulminant lung fibrosis with alveolitis. For four of the patients, the fibrosing alveolitis was fatal. All patients were RF positive and above 60 years and five had mild fibrosis associated with RA before TNF-blockade treatment. Duration of TNF-blockade treatment was for three patients only two months and for the other three, 20-51 months. Age above 60 years and previous lung fibrosis appear to be risk factors for developing fibrosing alveolitis in RA patients treated with TNF-blockade.
肿瘤坏死因子（TNF）阻断剂已越来越多地用于治疗类风湿关节炎（RA）。然而，其安全性尚不清楚，并且已发现结核病和其他感染的风险增加。最近，也有报道称在用TNF阻断剂治疗的RA患者中出现了严重的纤维化肺泡炎。我们报告了另外6例RA患者，他们在接受英夫利昔单抗或依那西普治疗期间发生了伴有肺泡炎的暴发性肺纤维化。其中4例患者的纤维化肺泡炎是致命的。所有患者类风湿因子（RF）均为阳性，年龄均在60岁以上，并且5例患者在TNF阻断剂治疗前就有与RA相关的轻度纤维化。TNF阻断剂治疗的持续时间，3例患者仅为2个月，另外3例为20 - 51个月。60岁以上的年龄和既往肺纤维化似乎是在用TNF阻断剂治疗的RA患者中发生纤维化肺泡炎的危险因素。
