Department of Rheumatology, Clinical Research Center for Rheumatic Disease, NHO Kumamoto Saishunsou National Hospital, 2659 Suya, Kohshi, Kumamoto 861-1196, Japan.
Mod Rheumatol. 2012 Sep;22(5):727-37. doi: 10.1007/s10165-011-0577-6. Epub 2011 Dec 30.
This study was performed to evaluate the radiological features of and therapeutic responses to pulmonary disease caused by nontuberculous mycobacteria (NTM) in the setting of biological therapy for rheumatoid arthritis (RA).
We conducted a retrospective chart review of 13 patients from multiple centers who had developed pulmonary NTM disease during biological therapy for RA, including infliximab, etanercept, adalimumab, and tocilizumab.
Most cases were asymptomatic or resulted in only common-cold-like symptoms. Abnormalities in computed tomography (CT) imaging were protean and frequently overlapped. The most predominant pattern was nodular/bronchiectatic disease (six cases), followed by alveolar infiltrate (three cases), cavitary disease (two cases), and pulmonary nodules (two cases). In most cases, pulmonary NTM disease had spread from a preexisting lesion; in particular, bronchial/bronchiolar abnormalities. In three cases, one or more nodular lesions with or without calcification were a focus of disease. Following the discontinuation of biological agents, most patients responded to anti-NTM therapy. Two patients showed no exacerbation in the absence of any anti-NTM therapy. In one patient, restarting tocilizumab therapy while continuing to receive adequate anti-NTM therapy produced a favorable outcome. In two other patients with a previous history of pulmonary NTM disease, introducing biological therapy led to recurrence, but anti-NTM therapy was effective in these patients.
CT abnormalities of pulmonary NTM disease in RA patients receiving biological therapy were variable, but were not unique to this clinical setting. NTM disease can spread from preexisting structural abnormalities, even if they are minute. Contrary to our expectations, the therapeutic outcomes of pulmonary NTM disease were favorable in these patients.
本研究旨在评估生物治疗类风湿关节炎（RA）背景下非结核分枝杆菌（NTM）肺病的放射学特征和治疗反应。
我们对来自多个中心的 13 名在接受生物治疗 RA 过程中发生肺部 NTM 疾病的患者进行了回顾性图表审查，包括英夫利昔单抗、依那西普、阿达木单抗和托珠单抗。
大多数病例无症状或仅表现为普通感冒样症状。计算机断层扫描（CT）成像异常多种多样且经常重叠。最主要的模式是结节/支气管扩张病变（6 例），其次是肺泡浸润（3 例）、空洞病变（2 例）和肺结节（2 例）。在大多数情况下，肺部 NTM 疾病从先前存在的病变扩散而来；特别是支气管/细支气管异常。在 3 例中，一个或多个伴有或不伴有钙化的结节性病变是疾病的焦点。停用生物制剂后，大多数患者对抗 NTM 治疗有反应。2 例在没有任何抗 NTM 治疗的情况下无恶化。在 1 例患者中，在继续接受充分抗 NTM 治疗的同时重新开始托珠单抗治疗产生了良好的结果。在另外 2 例有先前肺部 NTM 病史的患者中，引入生物治疗导致复发，但这些患者的抗 NTM 治疗有效。
接受生物治疗的 RA 患者肺部 NTM 病的 CT 异常多种多样，但在这种临床环境中并非独一无二。NTM 疾病可以从先前存在的结构异常传播，即使它们很小。与我们的预期相反，这些患者的肺部 NTM 病的治疗结果是有利的。
