REVIEW - The pulmonological manifestations of RA

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Orv Hetil. 2008 Jul 20;149(29):1355-61.

[The pulmonological manifestations of rheumatoid arthritis][Article in

Hungarian]

Bernscherer G, Karabélyos C, Tarján Z.

Bernscherer és Tsa Bt. Budapest.

In their review article the authors overview the primary and secondary

pulmonary complications of rheumatoid arthritis with the help of

bibliographic data. They emphasize the pulmonological complications of

disease modifying antirheumatic drugs used for the pharmaceutical

therapy of rheumatoid arthritis, of which they discuss the

methotrexate induced pulmonary diseases. Methotrexate participates

nearly in all of additive double and triple--O'Dell-scheme--combined

disease modifying antirheumatic drugs therapy. Because of that, the

early detection of drug-induced pulmonological complications is

important. For rheumatologists the treatment of methotrexate resistant

rheumatoid arthritis is always getting a higher and higher challenge.

Biological therapeutical drugs act as cytokine antagonists, by

blocking TNF-alpha and, compared to disease modifying antirheumatic

drugs, they can more effectively inhibit the progression of the

disease. These are the biological response modifiers. Their main

representatives are infliximab, adalimumab, and etanercept. At the

end, the authors discuss secondary pulmonary complications caused by

biological response modifiers, e.g. the biological response modifiers

associated pulmonary tuberculosis, bacterial tracheobronchitis,

bacterial pneumonia, bronchiectasia, pulmonary oedema, rapid fibrosing

alveolitis, and coccidioidomycosis. At 3% of patients with rheumatoid

arthritis, treated with biological response modifiers, who live in

Arizona, California, Nevada, pulmonary and systemic

mycosis--coccidioidomycosis can appear with a 15% of mortality. As a

consequence of frequent earthquakes, the spores getting into the air

from the ground infect immunosuppressed patients treated with

biological response modifiers. The authors draw attention to the fact

that patients who receive biological therapy and travel to the

above-mentioned endemic or earthquake-active regions, have a potential

high risk, so it is indispensable that they are informed by the

doctor. Testing and use of newer and newer groups of biological

response modifiers are expected in the near future in the therapy of

rheumatoid arthritis. Nowadays--in patients, who are non-reactive for

TNF-alpha inhibitor treatment--the use of B-lymphocyte inhibitor

rituximab, characteristic in non-Hodgkin lymphoma therapy is possible.

The pulmonary complications of rheumatoid arthritis therapy of that

cytokine are not known yet. Today, antirheumatic therapy results in a

significant improvement of patients' life-quality, whilst the more and

more modern therapeutical methods cause more complications.

PMID: 18617467

http://www.ncbi.nlm.nih.gov/pubmed/18617467

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