Picchianti Diamanti Andrea, Markovic Milica, Argento Giuseppe, Giovagnoli Simonetta, Ricci Alberto, Laganà Bruno, D'Amelio Raffaele
Department of Clinical and Molecular Medicine, School of Medicine and Psychology, 'Sapienza' University of Rome, Sant'Andrea University Hospital, Via di Grottarossa 1039, Rome 00189, Italy.
Department of Clinical and Molecular Medicine, School of Medicine and Psychology, 'Sapienza' University of Rome, Sant'Andrea University Hospital, Rome, Italy.
Ther Adv Respir Dis. 2017 Jan;11(1):64-72. doi: 10.1177/1753465816668780. Epub 2016 Oct 12.
Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that can present different extrarticular manifestations involving heart, lungs and kidneys. In recent years there has been a growing awareness of the central role played by the lungs in the onset and progression of RA. In particular interstitial lung disease (ILD) is a common pulmonary manifestation that may be related to the inflammatory process itself, infectious complications and to the treatments used. Management of patients with ILD/RA is still a challenge for clinicians, both synthetic [mainly methotrexate (MTX), leflunomide] and biologic immunosuppressors [mainly anti-tumor necrosis factor (TNF)α] have in fact been related to the onset or worsening of lung diseases with conflicting data. Here we report the case of a 61-year-old male patient with severely active early RA, previously treated with MTX, who developed subacute ILD, along with a review of ILD/RA topic. Tocilizumab (humanized monoclonal antibody against the interleukin-6 receptor) was introduced on the basis of its effectiveness in RA without concomitant MTX and the ability to overcome the profibrotic effects of interleukin (IL)-6. After 3 months of treatment the clinical condition of the patient strongly improved until it reached low disease activity. He no longer complained of cough and dyspnea and bilateral basal crackles were no more present. Considering its distinctive features, tocilizumab, in such a challenging clinical condition, appears to be a safe and effective therapy, thus it enables RA remission without deteriorating ILD, at 1-year follow up, as confirmed by ultrasonography of the affected joints and chest high-resolution computed tomography (HRCT).
类风湿关节炎（RA）是一种炎症性自身免疫性疾病，可出现累及心脏、肺和肾脏的不同关节外表现。近年来，人们越来越意识到肺在RA的发病和进展中所起的核心作用。特别是间质性肺疾病（ILD）是一种常见的肺部表现，可能与炎症过程本身、感染并发症以及所用治疗方法有关。ILD/RA患者的管理对临床医生来说仍然是一项挑战，事实上，合成免疫抑制剂[主要是甲氨蝶呤（MTX）、来氟米特]和生物免疫抑制剂[主要是抗肿瘤坏死因子（TNF）α]都与肺部疾病的发生或恶化有关，数据相互矛盾。在此，我们报告一例61岁男性患者，患有严重活动期早期RA，此前接受过MTX治疗，后来发展为亚急性ILD，并对ILD/RA主题进行综述。基于托珠单抗（一种抗白细胞介素-6受体的人源化单克隆抗体）在RA治疗中的有效性，且无需同时使用MTX，以及其克服白细胞介素（IL）-6促纤维化作用的能力，开始使用该药物治疗。经过3个月的治疗，患者的临床状况显著改善，直至达到低疾病活动度。他不再抱怨咳嗽和呼吸困难，双侧肺底湿啰音也消失了。考虑到其独特的特点，在这种具有挑战性的临床情况下，托珠单抗似乎是一种安全有效的治疗方法，因此在1年的随访中，它能够使RA缓解而不使ILD恶化，这一点通过患侧关节超声检查和胸部高分辨率计算机断层扫描（HRCT）得到证实。
