Vacchi Caterina, Manfredi Andreina, Cassone Giulia, Cerri Stefania, Della Casa Giovanni, Andrisani Dario, Salvarani Carlo, Sebastiani Marco
PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Via Del Pozzo 71, Modena 41125, Italy.
Rheumatology Unit, University of Modena and Reggio Emilia, Via Del Pozzo 71, Modena 41125, Italy.
Case Rep Med. 2021 Apr 22;2021:6652845. doi: 10.1155/2021/6652845. eCollection 2021.
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease characterized by chronic symmetrical erosive synovitis and extra-articular manifestations, including interstitial lung disease (ILD), whose treatment is nowadays challenging due to high infectious risk and possible pulmonary iatrogenic toxicity. Janus kinase inhibitors, namely, tofacitinib, baricitinib, and upadacitinib, are the latest drug class for the treatment of RA with a good safety profile. We present the case of a patient with RA-ILD successfully treated with tofacitinib. A 52-year-old man was referred to our multidisciplinary clinic for rheumatic and pulmonary diseases for an active erosive seropositive RA and progressive ILD. Previous treatments were GC, hydroxychloroquine, methotrexate, etanercept, withdrawn after ILD detection, and tocilizumab, discontinued due to relapsing infections. After our evaluation, we proposed rituximab in addition to low-dose GC and hydroxychloroquine, ineffective on joint involvement. Therefore, we proposed tofacitinib which allowed us to control joint involvement, stabilize ILD improving respiratory symptoms, and manage the frequent infectious episodes that occurred initially. The short half-life and rapid-acting of tofacitinib are two helpful characteristics regarding this aspect. Despite limited data from randomized trials and real-life, tofacitinib could represent a safe therapeutic option for RA-ILD patients. Longitudinal studies are required to confirm this encouraging report.
类风湿关节炎（RA）是一种慢性全身性炎症性疾病，其特征为慢性对称性侵蚀性滑膜炎和关节外表现，包括间质性肺疾病（ILD），由于感染风险高和可能的肺部医源性毒性，目前其治疗具有挑战性。Janus激酶抑制剂，即托法替布、巴瑞替尼和乌帕替尼，是治疗RA的最新一类药物，安全性良好。我们报告了一例用托法替布成功治疗的RA-ILD患者的病例。一名52岁男性因活动性侵蚀性血清阳性RA和进行性ILD被转诊至我们的风湿和肺病多学科诊所。既往治疗包括糖皮质激素（GC）、羟氯喹、甲氨蝶呤、依那西普（在检测到ILD后停用）和托珠单抗（因反复感染而停药）。经我们评估后，除低剂量GC和羟氯喹外，我们建议使用利妥昔单抗，但对关节受累无效。因此，我们建议使用托法替布，它使我们能够控制关节受累，稳定ILD并改善呼吸道症状，以及处理最初出现的频繁感染发作。托法替布的半衰期短和起效快是这方面的两个有益特性。尽管随机试验和实际应用中的数据有限，但托法替布可能是RA-ILD患者的一种安全治疗选择。需要进行纵向研究来证实这一令人鼓舞的报告。
