Development of Rheumatoid Arthritis During Anti-Interleukin-5 Therapy in a Patient with Refractory Chronic Eosinophilic Pneumonia
Hiroki Kawabata,1 Minoru Satoh,2 Kazuhiro Yatera1 1Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, 807-8555, Japan; 2Department of Clinical Nursing, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, 807-8555, Japan...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2021-11-01
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| Series: | Journal of Asthma and Allergy |
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| Online Access: | https://www.dovepress.com/development-of-rheumatoid-arthritis-during-anti-interleukin-5-therapy--peer-reviewed-fulltext-article-JAA |
| _version_ | 1818836413652664320 |
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| author | Kawabata H Satoh M Yatera K |
| author_facet | Kawabata H Satoh M Yatera K |
| author_sort | Kawabata H |
| collection | DOAJ |
| description | Hiroki Kawabata,1 Minoru Satoh,2 Kazuhiro Yatera1 1Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, 807-8555, Japan; 2Department of Clinical Nursing, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, 807-8555, JapanCorrespondence: Hiroki KawabataDepartment of Respiratory Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishiku, Kitakyushu, Fukuoka, 807-8555, JapanTel +81-93-691-7453Fax +81-93-602-9373Email hirokik@med.uoeh-u.ac.jpPurpose: To report the case of a patient with refractory chronic eosinophilic pneumonia who developed rheumatoid arthritis during anti-interleukin (IL)-5 therapy.Case Report: The case of a 66-year-old male ex-smoker with allergic rhinitis who had dyspnea and chronic cough for 6 months and who was ultimately diagnosed with chronic eosinophilic pneumonia is reported. Long-term corticosteroid therapy was necessary due to recurrence of the chronic eosinophilic pneumonia during tapering of the corticosteroid. As a steroid sparing strategy, mepolizumab was initiated, and the steroid was tapered gradually. When the dose of prednisolone was 2 mg/day, he developed polyarthralgia. Mepolizumab was changed to benralizumab considering the possibility that arthralgia was a side effect of mepolizumab; however, the arthralgia continued and he was ultimately diagnosed with rheumatoid arthritis. Methotrexate was initiated and his arthritis improved. Thereafter, benralizumab was discontinued after 5 injections, and he subsequently required neither systemic corticosteroids nor biologics.Conclusion: The present case may suggest that suppression of IL-5 induces rheumatoid arthritis in certain patients; however, it is also possible that initial steroid therapy improved subclinical RA and made it remain undiagnosed, and the parallel OCS tapering during IL-5 therapy could have contributed to unveil the underlying RA. Further studies are required to establish guidelines on the optimum use of anti-IL-5 therapy and to understand the interactions between chronic eosinophilic pneumonia, anti-IL-5 therapy, tapering of corticosteroid and development of rheumatoid arthritis.Keywords: asthma, chronic eosinophilic pneumonia, rheumatoid arthritis, mepolizumab, benralizumab |
| first_indexed | 2024-12-19T03:06:13Z |
| format | Article |
| id | doaj.art-71c31f0fde8d4774bda86c2ad39f287c |
| institution | Directory Open Access Journal |
| issn | 1178-6965 |
| language | English |
| last_indexed | 2024-12-19T03:06:13Z |
| publishDate | 2021-11-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Asthma and Allergy |
| spelling | doaj.art-71c31f0fde8d4774bda86c2ad39f287c2022-12-21T20:38:06ZengDove Medical PressJournal of Asthma and Allergy1178-69652021-11-01Volume 141425143070942Development of Rheumatoid Arthritis During Anti-Interleukin-5 Therapy in a Patient with Refractory Chronic Eosinophilic PneumoniaKawabata HSatoh MYatera KHiroki Kawabata,1 Minoru Satoh,2 Kazuhiro Yatera1 1Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, 807-8555, Japan; 2Department of Clinical Nursing, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, 807-8555, JapanCorrespondence: Hiroki KawabataDepartment of Respiratory Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishiku, Kitakyushu, Fukuoka, 807-8555, JapanTel +81-93-691-7453Fax +81-93-602-9373Email hirokik@med.uoeh-u.ac.jpPurpose: To report the case of a patient with refractory chronic eosinophilic pneumonia who developed rheumatoid arthritis during anti-interleukin (IL)-5 therapy.Case Report: The case of a 66-year-old male ex-smoker with allergic rhinitis who had dyspnea and chronic cough for 6 months and who was ultimately diagnosed with chronic eosinophilic pneumonia is reported. Long-term corticosteroid therapy was necessary due to recurrence of the chronic eosinophilic pneumonia during tapering of the corticosteroid. As a steroid sparing strategy, mepolizumab was initiated, and the steroid was tapered gradually. When the dose of prednisolone was 2 mg/day, he developed polyarthralgia. Mepolizumab was changed to benralizumab considering the possibility that arthralgia was a side effect of mepolizumab; however, the arthralgia continued and he was ultimately diagnosed with rheumatoid arthritis. Methotrexate was initiated and his arthritis improved. Thereafter, benralizumab was discontinued after 5 injections, and he subsequently required neither systemic corticosteroids nor biologics.Conclusion: The present case may suggest that suppression of IL-5 induces rheumatoid arthritis in certain patients; however, it is also possible that initial steroid therapy improved subclinical RA and made it remain undiagnosed, and the parallel OCS tapering during IL-5 therapy could have contributed to unveil the underlying RA. Further studies are required to establish guidelines on the optimum use of anti-IL-5 therapy and to understand the interactions between chronic eosinophilic pneumonia, anti-IL-5 therapy, tapering of corticosteroid and development of rheumatoid arthritis.Keywords: asthma, chronic eosinophilic pneumonia, rheumatoid arthritis, mepolizumab, benralizumabhttps://www.dovepress.com/development-of-rheumatoid-arthritis-during-anti-interleukin-5-therapy--peer-reviewed-fulltext-article-JAAasthmachronic eosinophilic pneumoniarheumatoid arthritismepolizumabbenralizumab |
| spellingShingle | Kawabata H Satoh M Yatera K Development of Rheumatoid Arthritis During Anti-Interleukin-5 Therapy in a Patient with Refractory Chronic Eosinophilic Pneumonia Journal of Asthma and Allergy asthma chronic eosinophilic pneumonia rheumatoid arthritis mepolizumab benralizumab |
| title | Development of Rheumatoid Arthritis During Anti-Interleukin-5 Therapy in a Patient with Refractory Chronic Eosinophilic Pneumonia |
| title_full | Development of Rheumatoid Arthritis During Anti-Interleukin-5 Therapy in a Patient with Refractory Chronic Eosinophilic Pneumonia |
| title_fullStr | Development of Rheumatoid Arthritis During Anti-Interleukin-5 Therapy in a Patient with Refractory Chronic Eosinophilic Pneumonia |
| title_full_unstemmed | Development of Rheumatoid Arthritis During Anti-Interleukin-5 Therapy in a Patient with Refractory Chronic Eosinophilic Pneumonia |
| title_short | Development of Rheumatoid Arthritis During Anti-Interleukin-5 Therapy in a Patient with Refractory Chronic Eosinophilic Pneumonia |
| title_sort | development of rheumatoid arthritis during anti interleukin 5 therapy in a patient with refractory chronic eosinophilic pneumonia |
| topic | asthma chronic eosinophilic pneumonia rheumatoid arthritis mepolizumab benralizumab |
| url | https://www.dovepress.com/development-of-rheumatoid-arthritis-during-anti-interleukin-5-therapy--peer-reviewed-fulltext-article-JAA |
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