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[Lung injury associated with bucillamine therapy]
1First Department of Internal Medicine, Showa University School of Medicine, Tokyo.
Ryumachi. [Rheumatism]
|April 1, 1992
Summary
Bucillamine treatment for rheumatoid arthritis can cause lung injury, particularly in older patients. This hypersensitivity reaction may be linked to HLA-DR4 and positive drug lymphocyte stimulation tests.
Area of Science:
- Rheumatology
- Pulmonology
- Immunology
Context:
- Interstitial pneumonitis and lung injury are potential adverse effects of bucillamine therapy in rheumatoid arthritis patients.
- Over a dozen cases have been reported since 1989, necessitating further investigation into associated factors.
Purpose:
- To survey and identify similarities among patients experiencing lung injuries while undergoing bucillamine treatment for rheumatoid arthritis.
- To explore potential immunological mechanisms underlying bucillamine-induced lung injury.
Summary:
- A survey of 10 patients with bucillamine-associated lung injury revealed a mean age of 65, with 7 females and 3 males.
- Patients typically received 20-40g of bucillamine over approximately 100 days. Serum rheumatoid factor was positive in 90% of cases, and HLA-DR4 was significantly detected in all patients.
- Positive drug lymphocyte stimulation tests (DLST) were observed in 50% of tested cases, suggesting a cell-mediated hypersensitivity reaction (Coombs & Gell type IV) may play a role.
Impact:
- The findings suggest that bucillamine therapy, despite its efficacy in managing rheumatoid disease activity, carries a risk of lung injury.
- Identifying HLA-DR4 association and positive DLST results points towards hypersensitivity as a key mechanism, aiding in risk assessment and patient monitoring.
- This research contributes to understanding drug-induced lung diseases and informs clinical practice regarding bucillamine use in rheumatoid arthritis.