Obliterative bronchiolitis in rheumatoid arthritis

Area of Science:

• Rheumatology
• Pulmonology
• Pharmacology

Background:

• Rheumatoid arthritis (RA) is a chronic autoimmune disease.
• Penicillamine is a disease-modifying antirheumatic drug (DMARD) used in RA treatment.
• Obliterative bronchiolitis is a rare but severe lung disease.

Observation:

• Two RA patients developed obliterative bronchiolitis after penicillamine therapy.
• The first patient experienced respiratory failure and died 4 months post-diagnosis.
• The second patient was diagnosed via lung function tests.

Findings:

• Penicillamine-induced obliterative bronchiolitis can be fatal.
• Azathioprine treatment was initiated for the second patient.
• The second patient's condition stabilized after 12 months, though breathlessness persisted.

Implications:

• Highlights a severe adverse pulmonary effect of penicillamine in RA patients.
• Suggests the need for vigilant respiratory monitoring in patients on penicillamine.
• Indicates potential benefit of immunosuppressive therapy (e.g., azathioprine) in managing this condition.