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Disease-modifying antirheumatic drugs and organising pneumonia

Mohamed Faisal1, Asyraf Roslan1, Nik Nuratiqah Nik Abeed1

  • 1Respiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia.

BMJ Case Reports
|January 7, 2021
PubMed

Insights

Rheumatoid arthritis patients can develop organizing pneumonia (OP) due to medications like methotrexate and leflunomide. Early diagnosis and treatment with corticosteroids lead to recovery.

Area of Science:

  • Rheumatology
  • Pulmonology
  • Pharmacology

Background:

  • Organizing pneumonia (OP) in rheumatoid arthritis (RA) can be disease-related or drug-induced.
  • Disease-modifying antirheumatic drugs (DMARDs) are commonly used to manage RA.
  • Identifying drug-related pulmonary complications is crucial for patient management.

Observation:

  • A case series of two RA patients experiencing OP attributed to DMARDs.
  • Patient 1 developed OP 3 weeks after starting methotrexate (MTX).
  • Patient 2 developed OP while on MTX and leflunomide.

Findings:

  • High-resolution CT (HRCT) scans showed bilateral consolidations in one patient and left upper lobe consolidation in the other.
  • Both patients achieved complete radiological and clinical resolution with corticosteroid therapy and drug cessation/modification.
  • OP can occur with low-dose methotrexate and leflunomide, even early in treatment.

Implications:

  • This case series underscores the importance of considering drug-induced OP in RA patients presenting with pulmonary symptoms.
  • A high index of suspicion is necessary for timely diagnosis and effective management.
  • Understanding the potential pulmonary side effects of RA medications is vital for clinicians.
Keywords:
interstitial lung diseaserespiratory medicinerheumatoid arthritisrheumatology

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