Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Effects of Anti-TNF Agents on the Lung Function of Patients with Rheumatoid Arthritis: A Prospective Study.
Can1, Meryem, Karakurt3, Sait, Bulur1, Atilla, Atagunduz1, Pamir, Yavuz2, Sule, Direskeneli2, Haner, Inanc2, Nevsun
Marmara University Medical School, Division of Rheumatology, Istanbul, Turkey
Marmara University Medical School, Division of Rheumatology
Marmara University Medical SchoolDepartment of Pulmonary and Critical Care, Istanbul, Turkey
The current evidence argues for caution in using TNF-targeted therapies in rheumatoid arthritis (RA) patients with pre-existing lung disease. Although the etiology of interstitial lung disease (ILD) in RA is still unclear, several cytokines are believed to play important roles in the pathogenesis of ILD.
To investigate both beneficial and adverse effects of anti-TNFa agents on the lung function of patients with RA in a 6 months follow-up study, to determine whether high resolution computed tomography (HRCT) findings correlated with clinical and pulmonary function test (PFT) abnormalities and to identify whether serum cytokines levels have an association with ILD in RA.
Fourty RA patients (F/M:33/7) were enrolled to the study. Infliximab (n=9), etanercept (n=12) and adalimumab (n=19) were started according to current guidelines in Turkey. The rate of concomitant metotrexate usage was 70%. Disease activity was assessed by DAS28. HRCT, pulmonary function test (PFT) and diffusing capacity of the lung for carbon monoxide (DLCO) were performed in all patients before and after 6 months of anti-TNFa treatment. Serum cytokines were measured by multiplex ELISA assay (IL1, IL6, MCP, TNF, VEGF, IFN gamma, IL10, IL12, IL13) at baseline and at 6 month's visit.
Mean(SD) age was 48.8(11.8) and mean disease duration was 8.4(4.9) years. Anti-CCP and RF positivity were 55,6% and 80% respectively. Mean DAS28(SD) score was 5.5(1.1) and 4.2(3.2) at baseline and at 6 months' follow-up visit, respectively. None of the patients had severe respiratory involvement after starting treatment with anti-TNF agents. Significant improvements have been observed on respiratory parameters both by HRCT (77,5% vs 66,7%, p=0.01) and PFT (35.3% vs 30.8%, p=0.03) at 6 months' visit, however without a significant change in DLCO findings (14.7% vs 19.2%, p=0.3). At both evaluations bronchiectasis and interstitial lung disease were the most common pulmonary complications. When compared to the baseline findings, the number of patients with bronchiectasis and ILD also decreased (n=16/ 9 vs 10/6, respectively) at 6 months' visit. When the relationship of interstitial pulmonary involvement with the baseline HRCT, serum cytokine levels and serologic findings (RF, CCP) were analyzed, higher levels of IL10 (p=0.025), IL1beta (p=0.03) and MCP (p=0.027) were found to be associated with interstitial lung disease in RA.
Our results suggest that HRCT is sensitive for monitoring pleuropulmonary changes in RA patients. Anti-TNF agents seem to improve the chances of recovery in interstitial lung disease.
To cite this abstract, please use the following information:
Can, Meryem, Karakurt, Sait, Bulur, Atilla, Atagunduz, Pamir, Yavuz, Sule, Direskeneli, Haner, et al; Effects of Anti-TNF Agents on the Lung Function of Patients with Rheumatoid Arthritis: A Prospective Study. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1803