Vol.22 No.5

Original Article

Radiological features and therapeutic responses of pulmonary nontuberculous mycobacterial disease in rheumatoid arthritis patients receiving biological agents: a retrospective multicenter study in Japan

Authors

Shunsuke Mori1 , Hitoshi Tokuda2 , Fumikazu Sakai3 , Takeshi Johkoh4 , Akio Mimori5 , Norihiro Nishimoto6 , Sadatomo Tasaka7 , Kazuhiro Hatta8 , Hidekazu Matsushima9 , Shunji Kaise10 , Atsushi Kaneko11 , Shigeki Makino12, Seiji Minota13, Takashi Yamada14, Shinobu Akagawa15, Atsuyuki Kurashima16

  • Department of Rheumatology, Clinical Research Center for Rheumatic Disease, NHO Kumamoto Saishunsou National Hospital, 2659 Suya, Kohshi, Kumamoto, 861-1196, Japan
  • Department of Internal Medicine, Social Health Insurance Central General Hospital, Tokyo, Japan
  • Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, Saitama, Japan
  • Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Hyogo, Japan
  • Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
  • Laboratory of Immune Regulation, Wakayama Medical University, Wakayama, Japan
  • Division of Pulmonary Medicine, Keio University School of Medicine, Tokyo, Japan
  • Department of General Internal Medicine, Tenri Hospital, Nara, Japan
  • Division of Internal Medicine, Saitama Red Cross Hospital, Saitama, Japan
  • Division of Internal Medicine, Ohara General Hospital, Fukushima, Japan
  • Department of Orthopedic Surgery, NHO Nagoya Medical Center, Nagoya, Japan
  • Department of Internal Medicine, Osaka Medical College, Osaka, Japan
  • Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi, Japan
  • Department of Respiratory Medicine, Shizuoka City Hospital, Shizuoka, Japan
  • Center for Respiratory Disease, NHO Tokyo National Hospital, Tokyo, Japan
  • Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Fukujuji Hospital, Tokyo, Japan
Received:

26 September 2011

Accepted:

8 December 2011

Published online:

30 December 2011

Full Text

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Abstract

Objective This study was performed to evaluate the radiological features of and therapeutic responses to pulmonary disease caused by nontuberculous mycobacteria (NTM) in the setting of biological therapy for rheumatoid arthritis (RA).
Methods We conducted a retrospective chart review of 13 patients from multiple centers who had developed pulmonary NTM disease during biological therapy for RA, including infliximab, etanercept, adalimumab, and tocilizumab.
Results Most cases were asymptomatic or resulted in only common-cold-like symptoms. Abnormalities in computed tomography (CT) imaging were protean and frequently overlapped. The most predominant pattern was nodular/bronchiectatic disease (six cases), followed by alveolar infiltrate (three cases), cavitary disease (two cases), and pulmonary nodules (two cases). In most cases, pulmonary NTM disease had spread from a preexisting lesion; in particular, bronchial/bronchiolar abnormalities. In three cases, one or more nodular lesions with or without calcification were a focus of disease. Following the discontinuation of biological agents, most patients responded to anti-NTM therapy. Two patients showed no exacerbation in the absence of any anti-NTM therapy. In one patient, restarting tocilizumab therapy while continuing to receive adequate anti-NTM therapy produced a favorable outcome. In two other patients with a previous history of pulmonary NTM disease, introducing biological therapy led to recurrence, but anti-NTM therapy was effective in these patients.
Conclusion CT abnormalities of pulmonary NTM disease in RA patients receiving biological therapy were variable, but were not unique to this clinical setting. NTM disease can spread from preexisting structural abnormalities, even if they are minute. Contrary to our expectations, the therapeutic outcomes of pulmonary NTM disease were favorable in these patients.

Key words

Computed tomography - Nontuberculous mycobacteria - Pulmonary disease - Rheumatoid arthritis - Biological therapy