Rituximab therapy in interstitial lung disease associated with rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) is a chronic systemic inflammatory disease. In this disease, interstitial lung diseases (ILD) is associated with high risk of mortality. Rituximab, a monoclonal antibody directed against CD20, is effective in the treatment of articular manifestations in RA while controversial results have been reported on rituximab efficacy in RA-ILD patients. AimsTo describe the clinical and radiological characteristics of 28 patients with RA-ILD and analyse the efficacy of anti-CD20 therapy in 14 RA-ILD patients treated with this drug for more than 1 year. ResultsIn our population, high resolution computed tomography features revealed usual interstitial pneumonia (UIP) in 15/28 (54%) of patients, non-specific interstitial pneumonia in 8/28 (29%) patients, other patients presented fibroelastosis and nodular fibrotic patterns. Higher mortality rate was observed in RA patients with radiological UIP pattern compared to those with different radiological patterns, although our patients with RA associated with radiological UIP pattern had a longer survival (7 years from ILD diagnosis) compared with literature data (3-5 years from ILD diagnosis). Half of our patients were treated with rituximab and they had a progressive reduction of lung function parameters. After 6 and 12 months of anti-CD20 therapy, our patients presented a stabilisation of lung function parameters. ConclusionOur study supported the theory that patients with RA and radiological UIP pattern at computed tomography scan presented the worst survival; rituximab therapy seems to be effective stabilising ILD involvement and lung function deterioration.