A case of rheumatoid arthritis with multiple lung rheumatoid nodules successfully treated with tofacitinib

Abstract

Sporadic cases of rheumatoid nodules (RNs) in the lung during treatment with tumour necrosis factor (TNF) inhibitors have been reported, but no treatment has been established. Here, we report a case of symptomatic lung RNs refractory to abatacept (ABT) and intravenous cyclophosphamide (IVCY) that improved with tofacitinib (TOF) treatment. A 75-year-old Japanese woman with a 10-year history of rheumatoid arthritis (RA) presented with a cough and haemoptysis during treatment with etanercept (ETN). Radiographic examinations revealed multiple nodules that were diagnosed as lung RNs via biopsy. The ETN was discontinued and ABT followed by IVCY was introduced; however, neither was sufficiently effective against the lung RNs. Thereafter, TOF was started and the lung RNs improved rapidly. The precise mechanisms that induce RNs during treatment with TNF inhibitors are unknown. Cytokines (IL-23 and IL-6) are suspected to be involved. TOF may be a reasonable strategy for treating symptomatic lung RNs.

Keywords:

• Rheumatoid arthritis
• rheumatoid nodules
• lung
• tofacitinib
• IL-6

Patient consent

Written informed consent for the publication of this report was obtained from the patient by the corresponding author.

Ethical approval

Not applicable.

Conflict of interest

Kondo M. has received speaking fee from Eisai Co. Ltd, Chugai Pharma Co. Ltd, Mitsubishi-Tanabe Pharma, Bristol-Myers Squibb, Janssen Pharma K.K., Astellas Pharma Inc, Takeda Pharma Co. Nippon Kayaku Co. Ltd, Daiichi-Sankyo Co. Ltd, Asahi Kasei Pharma Co. and AbbVie Japan. Murakawa Y has received grants from Asahi Kasei Pharmaceutical Co., Ltd., Chugai Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Daiichi-Sankyo Co., Ltd., Teijin Pharma Ltd., Eisai Co., Ltd., Nippon Kayaku Co., Ltd. and Mitsubishi-Tanabe Pharma Corporation, instructor fees from Asahi Kasei Pharmaceutical Co., Ltd., Kissei Pharmaceutical Co., Ltd. and Janssen Pharmaceutical K.K. Eisai Co., Ltd. and speaking fees from Ono Pharmaceutical Co., Ltd., Mitsubishi-Tanabe Pharma Corporation, Astellas Pharma Inc., UCB Japan Co. Ltd., Chugai Pharmaceutical Co., Ltd., AbbVie Japan, Daiichi-Sankyo Co., Ltd., AYUMI Pharmaceutical Corporation, Janssen Pharmaceutical K.K., Takeda Pharmaceutical Co. Ltd, Sanofi K.K., Teijin Pharma Ltd., Eli Lilly Japan K.K. and Eisai Co., Ltd. Honda M has received speaking fees from Asahi Kasei Pharma Corporation and Ono Pharmaceutical Co., LTD. Moriyama M has received speaking fees from Mitsubishi-Tanabe Pharma Corporation, Janssen Pharmaceutical K.K. and manuscript fees from Sanofi K.K. Watanabe Y has received speaking fee from Chugai Pharma Co. Ltd. and Mitsubishi-Tanabe Pharma. Kakimaru H has received speaking fee from Chugai Pharma Co. Ltd., Astellas Pharma Inc, Takeda Pharma Co., Daiichi-Sankyo Co. Ltd., and AbbVie Japan. Yanagawa T and Nagasaki M have no COI.