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[Interstitial pneumonia treated with intermittent cyclophosphamide pulse therapy]
T Harada1, K Takayama, K Kimotsuki
1Research Institute for Diseases of the Chest, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi
|November 1, 1996
Summary
Interstitial pneumonia associated with rheumatoid arthritis can be effectively treated with cyclophosphamide pulse therapy when corticosteroids fail. This approach offers a viable alternative for managing refractory cases.
Area of Science:
- Rheumatology
- Pulmonology
- Oncology
Background:
- Rheumatoid arthritis (RA) can manifest with interstitial pneumonia (IP), a serious complication.
- Corticosteroid therapy is a standard treatment for RA-associated IP, but treatment resistance can occur.
Observation:
- A 52-year-old woman with RA presented with polyarthralgia and dry cough, exhibiting bilateral diffuse reticulo-nodular shadows on chest X-ray.
- Transbronchial lung biopsy confirmed interstitial pneumonia with mononuclear cell infiltration.
- The patient experienced relapse of IP despite initial corticosteroid pulse therapy.
Findings:
- A treatment regimen combining cyclophosphamide pulse therapy with gradually reduced corticosteroid doses was initiated.
- The patient received three cycles of cyclophosphamide pulse therapy (700 mg monthly) and oral corticosteroids were reduced from 60 mg to 35 mg.
- No significant adverse events such as bone marrow suppression or hemorrhagic cystitis were observed.
Implications:
- Intermittent cyclophosphamide pulse therapy demonstrates efficacy in treating corticosteroid-unresponsive interstitial pneumonia associated with rheumatoid arthritis.
- This therapeutic strategy offers a potential alternative for patients with refractory RA-IP, avoiding severe side effects.