Treatment of interstitial lung disease (ILD) in rheumatoid arthritis (RA) has been controversial. Although there have been several anecdotal reports on the efficacies of corticosteroids or cytotoxic agents such as methotrexate, cyclophosphamide, azathioprine, and D-penicillamine for the treatment of ILD associated with RA, no controlled studies have been performed. To date, corticosteroids have been a central agent for the treatment of this disease, but their effects are partial and temporary in most cases. In addition, the adverse effects of these agents are considerable. On the other hand, limited information is available on the cyclosporine use in ILD associated with RA. We describe a 49-yr old female patient with RA and ILD that had initially responded to high dose prednisolone and cyclophosphamide intravenous pulse therapy, and the lung disease was aggravated with the tapering of prednisolone. After 10 months of follow-up loss, the patient was successfully treated with low dose cyclosporine without high dose corticosteroids.
Anti-Inflammatory Agents/therapeutic use ; Antirheumatic Agents/*therapeutic use ; Arthritis, Rheumatoid/complications/*drug therapy/radiography ; Cyclophosphamide/therapeutic use ; Cyclosporine/*therapeutic use ; Disease Progression ; Female ; Glucocorticoids/therapeutic use ; Humans ; Lung Diseases, Interstitial/complications/*drug therapy/radiography ; Middle Aged ; Prednisolone/therapeutic use ; Treatment Outcome

After 4-months of alpha interferon (IFN-alpha), a 64-year old woman with chronic hepatitis C developed a cough and dyspnea and showed diffuse infiltrative opacities on her chest X-ray. Her symptoms persisted after stopping the IFN-alpha therapy. Pulmonary function testing revealed a reduced forced vital capacity. High-resolution computed tomography of the lung showed peripheral and peribronchovascular ground glass attenuation and consolidation associated with reticulation. Bronchoalveolar lavage was performed for further evaluation and showed a lymphocyte level of 8.2%, an uncommon finding in IFN-alpha-induced interstitial pneumonitis. We performed a lung biopsy to diagnose her disease and it suggested interstitial pneumonitis. This was considered to be due to the immunomodulatory effects of INF-alpha. Although rare, any sign of significant pulmonary involvement should be evaluated.
Antiviral Agents/*adverse effects/therapeutic use ; Bronchoalveolar Lavage ; Female ; Hepatitis C, Chronic/complications/*drug therapy ; Humans ; Interferon-alpha/*adverse effects/therapeutic use ; Kidney Failure, Chronic/complications ; Lung Diseases, Interstitial/*chemically induced/pathology/radiography ; Middle Aged ; Respiratory Function Tests ; Tomography, X-Ray Computed