Boyd O, Gibbs A R, Smith A P
Department of Respiratory Medicine, Llandough Hospital, Cardiff, Wales.
Br J Rheumatol. 1990 Jun;29(3):222-4. doi: 10.1093/rheumatology/29.3.222.
Rheumatoid arthritis is being increasingly treated with sulphasalazine. We report the first case of a patient being treated for rheumatoid arthritis who developed severe dyspnoea with chest radiograph shadowing, reversible on discontinuation of sulphasalazine and subsequent steroid therapy. An histological diagnosis of fibrosing alveolitis was made. Thirteen cases of similar reactions to sulphasalazine, all in patients treated for inflammatory bowel disease, can be found in the literature. We identify two types of pulmonary reaction, an eosinophilic pneumonitis and a fibrosing alveolitis. Adequate histological investigation is needed to differentiate between the two and management may be different. The diagnosis of pulmonary reactions are important because they can be easily confused with complications of the underlying disease but the prognosis is much better.
类风湿关节炎越来越多地采用柳氮磺胺吡啶进行治疗。我们报告了首例接受类风湿关节炎治疗的患者，该患者出现严重呼吸困难且胸部X光有阴影，停用柳氮磺胺吡啶及随后进行类固醇治疗后症状可逆。经组织学诊断为纤维化肺泡炎。文献中可找到13例对柳氮磺胺吡啶有类似反应的病例，均为接受炎症性肠病治疗的患者。我们识别出两种肺部反应，即嗜酸性肺炎和纤维化肺泡炎。需要进行充分的组织学检查以区分两者，且治疗方法可能不同。肺部反应的诊断很重要，因为它们很容易与基础疾病的并发症相混淆，但预后要好得多。
