Hagiwara Kiyofumi, Sato Takeo, Takagi-Kobayashi Shoko, Hasegawa Shunsuke, Shigihara Nayumi, Akiyama Osamu
Department of Allergy and Rheumatology, Japanese Red Cross Medical Center, Tokyo, Japan.
J Rheumatol. 2007 May;34(5):1151-4. Epub 2007 Apr 15.
A 70-year-old woman with a 6-year history of seropositive rheumatoid arthritis (RA) and asymptomatic interstitial lung disease (ILD) began taking etanercept for ongoing arthritis despite treatment with methotrexate (MTX) and bucillamine. MTX was discontinued before introduction of etanercept. She developed lung injury 8 weeks after starting etanercept. Etanercept was discontinued and oral prednisolone 40 mg/day was begun, and her clinical findings gradually improved. Lung injury, although rare, is a recently noticed, potentially fatal adverse effect of all 3 licensed biological anti-tumor necrosis factor (TNF) agents. We recommend caution in the use of anti-TNF agents in elderly RA patients with preexisting ILD.
一名70岁女性，有6年血清阳性类风湿关节炎（RA）病史及无症状间质性肺疾病（ILD），尽管已接受甲氨蝶呤（MTX）和布西拉明治疗，仍因持续性关节炎开始使用依那西普。在开始使用依那西普之前停用了MTX。她在开始使用依那西普8周后出现肺损伤。停用依那西普并开始每日口服40 mg泼尼松龙，其临床症状逐渐改善。肺损伤虽然罕见，但却是最近发现的所有3种已获许可的生物抗肿瘤坏死因子（TNF）药物潜在的致命不良反应。我们建议在患有既往ILD的老年RA患者中谨慎使用抗TNF药物。
