Rheumatology Unit, University of Modena and Reggio Emilia, Univeritary Hospital Policlinico of Modena, Modena, Italy.
Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
Intern Med J. 2020 Sep;50(9):1085-1090. doi: 10.1111/imj.14670.
Interstitial lung disease (ILD) is the most severe extra-articular manifestation of rheumatoid arthritis (RA). Although it is responsible of 10-20% of all RA mortality, no controlled studies are available for the treatment of RA-ILD and its therapeutic approach is still debated.
To analyse the evolution of ILD in a population of RA patients treated with tocilizumab (TCZ).
In this national multicentre study, we retrospectively collected patients with RA-ILD treated with at least one dose of TCZ. For each patient, disease activity and serological data were evaluated. Moreover, we analysed the evolution of high-resolution computed tomography (HRCT) and pulmonary function tests, including forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLCO).
Twenty-eight RA-ILD patients were identified (females/males 18/10, mean age 61.6 years), with a mean follow up for TCZ therapy of 30 months. At the end of follow up, FVC remained stable in 14 (56%) patients, improved in 5 (20%) and worsened in 6 (24%). DLCO remained stable in 14 (56%) patients, improved in 5 (20%) and worsened in 6 (24%), even though in 3 patients DLCO and FVC showed an opposite trend. HRCT remained stable in the majority (25) of cases, worsened in two patients with a usual interstitial pneumonia pattern and improved in only one case with a non-specific interstitial pneumonia pattern.
The management of RA-ILD patients remains a critical unmet need. TCZ demonstrated a good safety profile in patients with RA-ILD and a potential effect on the stabilisation of lung involvement.
间质性肺疾病（ILD）是类风湿关节炎（RA）最严重的关节外表现。虽然它导致了 10-20%的 RA 死亡，但对于 RA-ILD 的治疗还没有对照研究，其治疗方法仍存在争议。
分析托西珠单抗（TCZ）治疗的 RA 患者ILD 的演变。
在这项全国多中心研究中，我们回顾性收集了至少接受过一次 TCZ 治疗的 RA-ILD 患者。对每个患者进行疾病活动度和血清学数据评估。此外，我们分析了高分辨率计算机断层扫描（HRCT）和肺功能检查（包括用力肺活量（FVC）和一氧化碳弥散量（DLCO））的演变。
共确定了 28 例 RA-ILD 患者（女性/男性 18/10，平均年龄 61.6 岁），TCZ 治疗的平均随访时间为 30 个月。随访结束时，14 例（56%）患者的 FVC 保持稳定，5 例（20%）患者改善，6 例（24%）患者恶化。14 例（56%）患者的 DLCO 保持稳定，5 例（20%）患者改善，6 例（24%）患者恶化，尽管在 3 例患者中，DLCO 和 FVC 呈相反趋势。大多数患者（25 例）的 HRCT 保持稳定，2 例患者的特发性间质性肺炎模式恶化，1 例非特异性间质性肺炎模式改善。
RA-ILD 患者的管理仍然是一个亟待解决的问题。TCZ 在 RA-ILD 患者中表现出良好的安全性，并可能对稳定肺部受累有一定作用。
