Abstract
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 Previous treatments were GC, hydroxychloroquine, methotrexate, etanercept, withdrawn after ILD detection, and tocilizumab, discontinued due to relapsing infections.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.
Highlights
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease affecting 0.5–1% of the population worldwide
interstitial lung disease (ILD) is a serious pulmonary complication of RA characterized by a significant impact on morbidity and mortality, representing a current therapeutic challenge because of the possible pulmonary toxicity of many traditional and biological disease modifying antirheumatic drugs (DMARDs), their unclear efficacy on pulmonary disease, and the higher infectious risk in comparison to nonILD RA patients [7, 8]
Janus kinase inhibitors (JAK-i) have recently emerged in clinical practice for the treatment of RA, and they are recommended by the European League against Rheumatism (EULAR) in patients failing an initial treatment with MTX or other conventional DMARDs with poor prognostic factors [14]
Summary
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease affecting 0.5–1% of the population worldwide. It is characterized by chronic symmetrical erosive synovitis and sometimes by extra-articular manifestations [1], including interstitial lung disease (ILD), which represents the most common lung involvement [2]. Sometimes lung interstitial involvement is early and represents the only sign of disease. In these cases, a clinical and serological follow-up may lead to evidence of autoimmune disease later in time [5]. Erapeutic options in these patients are complicated by the possible pulmonary toxicity of many disease modifying antirheumatic drugs (DMARDs) and by their unclear efficacy on pulmonary involvement [7]. We present the case of a patient affected with progressive RA-ILD successfully treated with tofacitinib
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