Successful Treatment of a Patient with Drug-Refractory Rheumatoid Arthritis-Associated Interstitial Lung Disease with Upadacitinib: A Case Report.
Yuuya NishiiMasaki OkamotoYoshiaki ZaizenTakashi KojimaTakashi NounoYoshiko Naitou-NishidaNorikazu MatsuoHiroaki TakeokaMotoko IshidaMasataka NakamuraToru MasudaTakafumi TanakaTomoya MiyamuraTomoaki HoshinoPublished in: Medicina (Kaunas, Lithuania) (2023)
Insufficient evidence exists regarding the efficacy of Janus kinase inhibitors (JAKis), a class of targeted synthetic disease-modifying anti-rheumatic drugs (tsDMARDs), in the treatment of rheumatoid arthritis (RA)-associated interstitial lung disease (ILD). Herein, we present a case of RA-ILD refractory to previous treatments that exhibited favorable response to upadacitinib. A 69-year-old man, former smoker, was diagnosed with RA-ILD based on persistent symmetric polyarthritis, elevated C-reactive protein levels and erythrocyte sedimentation rate, reduced diffusing capacity for carbon monoxide/alveolar volume (D LCO 69.9%), and bilateral ground-glass attenuation with traction bronchiectasis, predominantly in the lower lung lobe. Initial treatment with oral prednisolone and methotrexate was started; however, the patient showed worsening dyspnea, chest high-resolution computed tomography abnormalities, and decreased pulmonary function. The dose of prednisolone was increased, and methotrexate was shifted to tacrolimus; however, tacrolimus was eventually discontinued because of renal dysfunction. Subsequent treatment changes included abatacept followed by intravenous cyclophosphamide, but ILD activity continued to worsen and met the criteria of progressive pulmonary fibrosis. Approximately 4.5 years after the RA diagnosis, dyspnea, radiological abnormalities, and D LCO improved following treatment switch to upadacitinib, one of JAKis. JAKi therapy may have potential as a treatment option for refractory RA-ILD.
Keyphrases
- interstitial lung disease
- rheumatoid arthritis
- systemic sclerosis
- disease activity
- idiopathic pulmonary fibrosis
- computed tomography
- high resolution
- high dose
- cystic fibrosis
- ankylosing spondylitis
- case report
- mass spectrometry
- low dose
- magnetic resonance
- positron emission tomography
- combination therapy
- risk assessment
- mesenchymal stem cells
- bone marrow
- pet ct
- high speed