Abstract
Objective: To investigate the clinical effect of rituximab (RTX) in the management of progressive rheumatoid arthritis related interstitial lung disease (RA-ILD). Methods: A total of 10 patients with progressive RA-ILD were enrolled into this 48-week, open-label treatment study. Treatment was with RTX at 1000 mg at day 1, day 15, and again at weeks 24 and 26, with concomitant methotrexate therapy. Results: The study included 4 men and 6 women. Of 7 evaluable patients at week 48, the diffusing capacity to carbon monoxide had worsened by at least 15% in 1 patient, was stable in 4 patients, and increased by >15% of baseline value in 2 patients. The forced vital capacity declined by at least 10% in 1 patient, was stable in 4 patients, and increased by at least 10% in 2 patients. High resolution computed tomo-graphy of the chest showed improvement in 1 patient, and was unchanged in 5. Three patients were withdrawn, one who had an infusion reaction at week 0, one at week 5 who was hospitalized for congestive heart failure at week 5 and who later died at week 32 of complications following a traumatic hip fracture, and one died at week 6 of possible pneumonia. Conclusions: In this pilot study of 10 patients with RA-ILD treated with RTX, measures of lung disease remained stable in the majority of study completers. Further research is needed to clarify whether this treatment has a role in management of RA-ILD.
Highlights
Pulmonary involvement is common in patients with rheumatoid arthritis (RA), and clinically overt interstitial lung disease (ILD) is prevalent in about 8% of patients with early RA and 19% of patients with a longer disease duration [1,2,3]
In this pilot study of 10 patients with related interstitial lung disease (RA-ILD) treated with RTX, measures of lung disease remained stable in the majority of study completers
There may be a significant increase in B-cell numbers in RA-ILD compared to normal lung tissue and interstitial pneumonias (IIP), and there are dense B-cell follicles in the two most common histologic subtypes of RA-ILD, nonspecific interstitial pneumonia (NSIP) and usual interstitial pneumonia (UIP) [9]
Summary
Pulmonary involvement is common in patients with rheumatoid arthritis (RA), and clinically overt interstitial lung disease (ILD) is prevalent in about 8% of patients with early RA and 19% of patients with a longer disease duration [1,2,3]. The presence of ILD in RA has a significant adverse impact on mortality [2,4]. In view of some histologic differences between IIPs and their counterparts in RA, there might be important features which could impact on treatment efficacy and prognosis [3]. There may be a significant increase in B-cell numbers in RA-ILD compared to normal lung tissue and IIPs, and there are dense B-cell follicles in the two most common histologic subtypes of RA-ILD, nonspecific interstitial pneumonia (NSIP) and usual interstitial pneumonia (UIP) [9]
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