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.


Efficacy of Rituximab on Pulmonary Rheumatoid Nodules: Data of 10 Patients from the French AIR/PR Registry.

Glace7,  Baptiste, Gottenberg13,  Jacques E., Mariette1,  Xavier, Roche5,  Antoine, Berthelot11,  Jean-Marie, Dougados3,  Maxime, Toussirot6,  Eric

Bicetre Hospital/Paris Univ, Le Kremlin Bicetre, France
Rheumatology Department, CHU Nancy
Rheumatology Department, CHU Nantes
Rheumatology Department, CHU Rouen
Strasbourg Hospitals, Strasbourg, France
Hopitaux de Paris Cochin, Paris, France
Hospital Cochin, Paris, France
L'Archet Hospital (University), Nice, France
Radiology Department, CHU Clermont-Ferrand
Rheumatology Department, CHU Besançon
Rheumatology Department, CHU Clermont-Ferrand
Rheumatology Department, CHU Clermont-Ferrand
Rheumatology Department, CHU Marseille

Background:

Pulmonary rhumatoid nodules (PRN) occur in 5 to 20% of patients having rheumatoid arthritis (RA). DMARDs (methotrexate, leflunomide) and TNF blockers may accelerate pulmonary nodulosis. The presence of B CD 20 lymphocytes on their outer rim has raised the potential impact of Rituximab (RTX) as emphasized in a recent report [1].

Objectives:

We assessed the outcomes of patients with PRN from the French autoimmunity and RTX registry (AIR).

Method:

AIR is an independent registry under the aegis of the French society of Rheumatology. Standardized information was gathered every 6 months for 5 years by trained clinical nurses in each centre taking part. RA patients with pulmonary nodules observed on CT-scan at baseline and at follow up were included. Scanner readings were centralized (AR). The nodules were assessed according to their number and size (long axis).

Results:

Of the 2573 patients from 85 centres reviewed, 30 had PRN. 10 of these patients fitted the inclusion criteria: 8 women with a mean age of 66.5 ± 59/79 years and 2 men with a mean age of 56 ± 51/61 years. All the patients had erosive, seropositive, anti CCP positive RA. Nine patients had sub-cutaneous nodulosis. The nodules were found while the patients were undergoing treatment with methotrexate (MTX) (n=3), MTX in combination with etanercept (n=3) or adalimumab (n=1), adalimumab alone (n=1) and leflunomide in combination with etanercept (n=2). RTX was administred with MTX (n=4), leflunomide (n=2), salazopyrine and hydroxychloroquine (n=1) or alone (n = 3). Nine patients were receiving corticosteroids (prednisolone) with a mean dose of 10.8 ± (5.20) mg. With a mean follow-up of 11.5±8.2 months, twenty one out of the 27 nodules studied improved (78%) and the mean long axis decreased from 14.4 ± 7.8 mm to 8.5 ± 9mm (p=0.001). Fourteen nodules had improved after a mean follow-up of 8.3±2.7 months (mean long axis from 14.4±9mm to 11.3±8.9mm). Seven nodules had disappeared after a mean follow-up of 19.5±17.6 months (mean long axis at baseline: 15.5±5.5mm). Six nodules worsened after a mean follow-up of 14.8±0.7 months (mean long axis from 14.8±10mm to 17.8±9.8mm).

Conclusion:

RTX seems to be effective in treating pulmonary rheumatoid nodules.

(1)Favorable response of pulmonary rheumatoid nodule to Rituximab Oqueka T, Schultz H, Moosig F.Z Rheumatol.2009 Jun;68(4):343-4.

To cite this abstract, please use the following information:
Glace, Baptiste, Gottenberg, Jacques E., Mariette, Xavier, Roche, Antoine, Berthelot, Jean-Marie, Dougados, Maxime, et al; Efficacy of Rituximab on Pulmonary Rheumatoid Nodules: Data of 10 Patients from the French AIR/PR Registry. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1810
DOI: 10.1002/art.29575

Abstract Supplement

Meeting Menu

2010 ACR/ARHP