A case of chronic eosinophilic pneumonia associated with rheumatoid arthritis in glucocorticoid-free remission with JAK inhibitor: A case report.
A case of chronic eosinophilic pneumonia associated with rheumatoid arthritis in glucocorticoid-free remission with JAK inhibitor: A case report.
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DOI：
10.1097/md.0000000000033396
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发表时间：
2023-03-31
期刊：
影响因子：
1.6
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中科院分区：
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慢性嗜酸性粒细胞性肺炎（CEP）是由于过敏反应引起的肺部嗜酸性粒细胞浸润。大多数CEP患者继续服用糖皮质激素，长期使用会引起各种副作用。在本病例报告中，基于baricitinib在类风湿性关节炎（RA）和CEP患者中的疗效，我们旨在证明当RA并发过敏性疾病时，Janus激酶（JAK）抑制剂的给药可以稳定疾病状态，并有助于避免长期全身性糖皮质激素给药的不良反应。一位56岁的女性在19岁时患上了类风湿关节炎。开始治疗关节炎，但关节破坏进展。42岁时，她出现嗜酸性粒细胞性肺炎，经糖皮质激素治疗后缓解。从那时起，维持治疗一直继续与CEP的诊断。患者接受他克莫司合并治疗持续性关节炎，10年后泼尼松龙（PSL）剂量降至3 mg/天。然而，在此期间，观察到外周血嗜酸性粒细胞计数增加和呼吸道症状。外周血嗜酸性粒细胞计数为4000/µL，计算机断层扫描显示外周肺野多发毛玻璃样阴影。由于排除了感染或其他原因引起的间质性肺炎，诊断为CEP复发。当PSL剂量增加至15 mg/天时，肺炎迅速恢复，当PSL剂量降低至5 mg/天时，肺野沿着关节炎复发再次出现无症状嗜酸性粒细胞浸润。合并使用甲氨蝶呤和巴瑞替尼可抑制肺炎的过敏反应。在开始Baricitinib和甲氨蝶呤联合治疗后，关节炎和嗜酸性粒细胞增多症均得到改善，并且实现了无糖皮质激素缓解。最近，已经报道了通过JAK 2抑制IL-5信号传导在支气管哮喘和特应性皮炎中是有效的。尽管RA和CEP的并发症并不常见，但巴瑞替尼的作用不仅对关节炎有用，对过敏性疾病也有用。一些JAK抑制剂的疗效应积极测试RA患者和这些并发症。
Chronic eosinophilic pneumonia (CEP) presents eosinophil infiltrations in the lung due to allergic reactions. Most CEP patients continue to take glucocorticoids, and their prolonged use induces various side effects. In this case report, based on the efficacy of baricitinib in patients with rheumatoid arthritis (RA) and CEP, we aimed to show that the administration of Janus kinase (JAK) inhibitors, when RA is complicated by an allergic disease, can stabilize the disease state and help avoid the adverse effects of long-term systemic glucocorticoid administration. A 56-year-old woman developed RA at the age of 19 years. Treatment of the arthritis was initiated, but the joint destruction had progressed. At the age of 42, she developed eosinophilic pneumonia, which was relieved by glucocorticoid therapy. Since then, maintenance therapy has been continued with the diagnosis of CEP. She was treated with concomitant tacrolimus for persistent arthritis, and the prednisolone (PSL) dose was reduced to 3 mg/day after 10 years. However, around this time, an increase in peripheral blood eosinophil counts and respiratory symptoms was observed. The peripheral blood eosinophil count was 4000/µL and computed tomography revealed multiple ground-glass opacities in the peripheral lung fields. As interstitial pneumonia due to infection or other causes was ruled out, CEP relapse was diagnosed. Pneumonia rapidly recovered when the PSL dose was increased to 15 mg/day, and asymptomatic eosinophilic infiltrates reappeared in the lung field along with a relapse of arthritis when the PSL dose was reduced to 5 mg/day. Concomitant use of methotrexate and baricitinib has been introduced to suppress allergic reactions to pneumonia. After starting combination therapy with baricitinib and methotrexate, both arthritis and eosinophilia improved, and glucocorticoid-free remission was achieved. Recently, inhibition of IL-5 signaling via JAK2 has been reported to be effective in bronchial asthma and atopic dermatitis. Although complications of RA and CEP are not common, the actions of baricitinib are useful not only in arthritis but also in allergic diseases. The efficacy of some JAK inhibitors should be actively tested in patients with RA and these complications.