Rheumatoid Arthritis Preceded by Interstitial Lung Disease Controlled by Long-Term Treatment With the Janus Kinase...

Area of Science:

• Rheumatology
• Pulmonology
• Pharmacology

Background:

• Interstitial lung disease (ILD) can be associated with rheumatoid arthritis (RA).
• The temporal relationship and treatment of ILD preceding RA onset remain areas for further investigation.
• Early diagnosis and effective management are crucial for patients with overlapping ILD and RA.

Purpose of the Study:

• To report a case of active ILD preceding the clinical diagnosis of rheumatoid arthritis (RA).
• To evaluate the efficacy and safety of a Janus kinase (JAK) 1 inhibitor in managing co-existing ILD and RA.
• To explore the potential of JAK1 inhibitors for long-term treatment of ILD and RA.

Main Methods:

• A case report of a 68-year-old male with preceding ILD and subsequent RA diagnosis.
• Clinical assessment, pulmonary function tests, imaging (CT scan), and serological markers (rheumatoid factor, anti-CCP antibody) were utilized.
• Treatment involved salazosulfapyridine followed by the addition of filgotinib (a selective JAK1 inhibitor).

Main Results:

• The patient presented with ILD symptoms and imaging findings before developing clinical arthritis.
• Initial treatment with salazosulfapyridine was ineffective for arthritis.
• Addition of filgotinib led to improvement in both arthritis and ILD, with sustained remission for 4 years without adverse events.

Conclusions:

• Active ILD can precede the clinical manifestation of rheumatoid arthritis.
• Filgotinib, a selective JAK1 inhibitor, demonstrated safety and efficacy in treating both RA and ILD in this case.
• JAK1 inhibitors may offer a promising therapeutic option for long-term management of patients with co-existing RA and ILD.