Abstract: Pulmonary Complications of Infliximab Therapy in Patients with Rheumatoid Arthritis

Pulmonary Complications of Infliximab Therapy in Patients with Rheumatoid Arthritis

ANDREW J.K. ÖSTÖR, EDWIN R. CHILVERS, MARGARET F. SOMERVILLE, ANITA Y.N. LIM, SUZANNE E. LANE, ADRIAN J. CRISP, and DAVID G.I. SCOTT

ABSTRACT.

We describe 5 patients with rheumatoid arthritis (RA) who developed pulmonary complications following infliximab therapy; 4 patients had preexisting usual interstitial pneumonia. As the pathophysiology of the pulmonary insult is unknown, we advise caution in the use of anti-tumor necrosis factor-a therapy in patients with RA with underlying lung disease of sufficient severity to withhold methotrexate treatment. (J Rheumatol 2006;33:622–8)

Key Indexing Terms:

RHEUMATOID ARTHRITIS
INTERSTITIAL LUNG DISEASE
INFLIXIMAB
ANTI-TUMOR NECROSIS FACTOR-a THERAPY
USUAL INTERSTITIAL PNEUMONIA
BRONCHIOLITIS OBLITERANS ORGANIZING PNEUMONIA

From the Rheumatology Department, Addenbrooke's Hospital, Cambridge; Rheumatology Department, Norfolk and Norwich University Hospital, Norwich; and Division of Respiratory Medicine, Department of Medicine, School of Clinical Medicine, University of Cambridge, Addenbrooke's and Papworth Hospitals, Cambridge, UK.

A.J.K. Östör, FRACP, Consultant Rheumatologist, Rheumatology Department, Addenbrooke's Hospital; E.R. Chilvers, FRCP, PhD, Professor of Respiratory Medicine, Division of Respiratory Medicine, Department of Medicine, School of Clinical Medicine, University of Cambridge, Addenbrooke's and Papworth Hospitals; M.F. Somerville, MSc, BA (Hons), Rheumatology Clinical Research Manager, Rheumatology Department, Norfolk and Norwich University Hospital; A.Y.N. Lim, MRCP, Rheumatology Specialist Registrar, Rheumatology Department, Norfolk and Norwich University Hospital; S.E. Lane, FRCP, MD, Consultant Rheumatologist, Department of Rheumatology, The Ipswich Hospital NHS Trust, Ipswich; A.J. Crisp, FRCP, MD, Consultant Rheumatologist, Rheumatology Department, Addenbrooke's Hospital; D.G.I. Scott, FRCP, PhD, Professor of Rheumatology, Rheumatology Department, Norfolk and Norwich University Hospital.

Address reprint requests to Dr. A.J.K. Östör, Rheumatology Department, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK. E-mail: andrew.ostor@addenbrookes.nhs.uk

Accepted for publication October 17, 2005.