Abstract: Slide Presentations |

The Treatment of Interstitial Lung Disease Associated With Rheumatoid Arthritis With Infliximab FREE TO VIEW

Paul F. Dellaripa, MD; Thomas A. Fry, MD; Janet Willoughby, Medical Student; William F. Arndt, MD; Elizabeth J. Angelakis, MD; Anthony C. Campagna, MD
Author and Funding Information

Lahey Clinic Medical Center, Burlington, MA


Chest. 2003;124(4_MeetingAbstracts):109S. doi:10.1378/chest.124.4_MeetingAbstracts.109S-a
Text Size: A A A
Published online


PURPOSE:  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).

METHODS:  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.

RESULTS:  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.

CONCLUSION:  This case review suggests that inhibition of TNF-α with infliximab may slow the progression of ILD associated with RA.

CLINICAL IMPLICATIONS:  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 Treatment

PatientFVC1FVC2% ChangeDLCO1DLCO2% ChangeGround Glass1Ground Glass2% ChangeFibrosis1Fibrosis2% Change195994.241459.875.521.46.567.72595905441-24.10002203596510.2394412.82204.54.504718621.1375343.24.51.566.754.510589.579.7−1172742.84.54.50330

DISCLOSURE:  P.F. Dellaripa, None.

Tuesday, October 28, 2003

12:30 PM - 2:00 PM




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543