Rheumatoid lung nodulosis and osteopathy associated with leflunomide therapy

  title={Rheumatoid lung nodulosis and osteopathy associated with leflunomide therapy},
  author={Alexander P Rozin and Mordechai Yigla and Luda Guralnik and Zohar Keidar and Euvgeni Vlodavsky and Michael Rozenbaum and Abraham Menahem Nahir and Alexandra Balbir-Gurman},
  journal={Clinical Rheumatology},
BackgroundLeflunomide (LEF) is indicated in adults for the treatment of active rheumatoid arthritis (RA). LEF inhibits dehydroorotate dehydrogenase, a key enzyme of the pyrimidine synthesis in activated lymphocytes. Among rare adverse effects, fatal interstitial lung disease has been recently reported during treatment of RA with LEF in Japan. Clinical trials outside Japan do not suggest that LEF causes an excess of pulmonary adverse effects. Development and increase of peripheral rheumatoid… 
Pulmonary Nodulosis Associated with Leflunomide Therapy in Rheumatoid Arthritis: Report of Four Cases and Review of the Literature
It was shown that leflunomide can reduce signs and symptoms of rheumatoid arthritis (RA) with regression in structural damage and pulmonary nodule development.
Reappraisal of the clinical use of leflunomide in rheumatoid arthritis and psoriatic arthritis
Leflunomide remains one of the most useful of the nonbiologic DMARDs and practical advice informed by evidence is given regarding dosing regimens, safety monitoring, and managing side effects.
Methotrexate-Induced Pneumonitis in Rheumatoid Arthritis: Long-term Treatment With Tofacitinib Therapy.
The respiratory function tests (RFTs) showed a moderate decrease in the diffusing capacity, and Methotrexate was discontinued.
Intrapulmonary Rheumatoid Nodules in a Patient with Long-Standing Rheumatoid Arthritis Treated with Leflunomide
The X-ray, video-associated thoracoscopy and repeated biopsy of the lung followed by histology of the samples proved intrapulmonary rheumatoid nodules, caused by leflunomide.
Recurrent pneumothorax associated with pulmonary nodules after leflunomide therapy in rheumatoid arthritis: a case report and review of the literature
It is suggested that pneumothorax can be a rare respiratory fatal complication in patients with RA with pulmonary nodules and LEF can be the rare cause of these manifestations.
Поражение легких при ревматоидном артрите
The paper considers the types of lung injury in RA and main methods for diagnosis and therapy and the hypothesis advanced by M. Selman et al., that impaired alveolocyte regeneration processes after injury rather inflammation underlie the pathogenesis of pulmonary fibrosis.
Rheumatoid Arthritis with Necrotic Lung Nodules
A 74-year-old male with long-standing rheumatoid arthritis who had multiple cavitating lung nodules was empirically treated with a moderate dose of glucocorticoid along with conventional synthetic disease-modifying antirheumatic drugs and his articular symptoms showed marked improvement.
Accelerated pulmonary nodulosis and sterile pleural effusion in a patient with psoriatic arthropathy during methotrexate therapy: a case report.
A patient with psoriatic arthropathy, negative RF, negative anticyclic citrulinated peptide antibodies but positive antibodies to cardiolipin who developed massive sterile pleural empyema and multiple cavitary pulmonary nodules during methotrexate treatment is reported.
The effect of disease modifying drugs on the lung in patients with rheumatoid arthritis
In this review, the association between methotrexate, leflunomide, and newer biologic agents and lung disease in patients with rheumatoid arthritis is evaluated.


[Development and/or increase of rheumatoid nodules in RA patients following leflunomide therapy].
This is the first description of the development of rheumatoid nodules in 3 rheumatoid arthritis patients following leflunomide therapy. The nodules were localized at typical sites with preference of
The efficacy and safety of leflunomide in patients with active rheumatoid arthritis: a five-year followup study.
The improvements in both functional ability and physician-based efficacy measures seen with leflunomide after 1 year were maintained for up to 5 years (maximum treatment duration 5.8 years), demonstrating that the early efficacy of leflinomide in patients with RA is sustained long-term, and that the long- term safety profile of le flunomid is no different from that observed in phase III trials.
Accelerated nodulosis and vasculitis following etanercept therapy for rheumatoid arthritis.
Recent immunohistological studies of skin lesions, the generation and analysis of drug-specific T -cell lines (TCL) and T-cell clones (TCC) from allergic patients suggest that drug- specific T cells play a major role in these drug-induced skin reactions.
Rheumatoid nodules and cyclosporin A treatment.
The authors describe the appearance of rheumatoid nodules during cyclosporin A (CsA) therapy for RA and the relationship between CsA treatment and the onset of nodulosis is not clear and further studies are needed to assess the role of CsB treatment in the extra-articular manifestations of r heumatoid arthritis.
Adenosine A1 receptor promotion of multinucleated giant cell formation by human monocytes: a mechanism for methotrexate-induced nodulosis in rheumatoid arthritis.
Agents that inhibit adenosine A1 receptors might be useful in the treatment of MTX-induced rheumatoid nodulosis, while still potentiating the A2-mediated antiinflammatory effects ofMTX on synovitis.
Leflunomide inhibits transendothelial migration of peripheral blood mononuclear cells
LEF-M reduces monocytic adhesion molecule expression and TEM and may thus interfere with monocyte and EC activities in RA and may, at least in part, be due to blocking cell traffic into the inflamed synovia.
Neuauftreten und/oder Zunahme von Rheumaknoten unter Leflunomidtherapie bei RA-Patienten
One nodule examined histologically revealed the typical architecture of RA nodules, and in all 3 patients the time of onset of nodulosis was about 6 months after initiating the leflunomide therapy.
Accelerated nodulosis during azathioprine therapy.
Development of rheumatoid nodules during anti-tumor necrosis factor alpha therapy with etanercept.