Interstitial lung disease (ILD) associated with rheumatoid arthritis (RA) is a cause of significant morbidity and mortality. TNF-α is an important mediator of pulmonary inflammation and fibrosis. We report 5 patients with RA associated ILD treated with infliximab who exhibited stabilization or improvement in high resolution CT (HRCT) scores and in the majority of their pulmonary function tests (PFTs).
We retrospectively reviewed 5 patients with RA and biopsy proven ILD treated with infliximab. Patients underwent PFTs and HRCT before starting infliximab and again at a mean of 9.5 months later. Two chest radiologists scored the HRCTs using a scale validated for idiopathic pulmonary fibrosis, by grading the severity of ground glass and fibrosis in each lobe from 0 to 5 (5 being worst). The individual lobe scores were added to calculate a total lung score for ground glass and for fibrosis. These scores were then averaged between radiologists.
The mean age was 66, mean duration of RA was 5.5 years, and mean duration of lung disease was 4.8 years. The mean prednisone dose was stable at 9mg/d, except for patient 1 who required a taper (mean 17mg/d) over 5 months for treatment of dyspnea. PFTs revealed stability of FVC and of DLCO in 4 of the 5 patients. TLC was stable or improved in all patients. HRCT scores showed stabilization or improvement of ground glass and fibrosis scores in all patients.Positive percent change indicates improvement. Columns superscripted 1 are for baseline values, and 2 are for follow-up studies. PFT scores are reported as percent predicted. Clinical improvement in pulmonary function was defined as ≥ +10% change and worsening as ≥ −10% change.
This case review suggests that inhibition of TNF-α with infliximab may slow the progression of ILD associated with RA.
Prospective analysis is necessary to determine if TNF-α inhibition modulates progression of alveolitis and fibrosis in RA.
PFT and HRCT Scores and Percent Change after TreatmentPatientFVC1FVC2% ChangeDLCO1DLCO2% ChangeGround Glass1Ground Glass2% ChangeFibrosis1Fibrosis2% Change195994.241459.875.521.46.567.72595905441-24.10002203596510.2394412.82204.54.504718621.13753126.96.36.1996.754.510589.579.7−11727188.8.131.52330
P.F. Dellaripa, None.