$Development of Rheumatoid Arthritis During Anti-Interleukin-5 Therapy in a Patient with Refractory Chronic Eosinophilic Pneumonia$
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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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Autores principales:	Kawabata H, Satoh M, Yatera K
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	asthma chronic eosinophilic pneumonia rheumatoid arthritis mepolizumab benralizumab Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/71c31f0fde8d4774bda86c2ad39f287c
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spelling	oai:doaj.org-article:71c31f0fde8d4774bda86c2ad39f287c2021-11-25T18:55:29ZDevelopment of Rheumatoid Arthritis During Anti-Interleukin-5 Therapy in a Patient with Refractory Chronic Eosinophilic Pneumonia1178-6965https://doaj.org/article/71c31f0fde8d4774bda86c2ad39f287c2021-11-01T00:00:00Zhttps://www.dovepress.com/development-of-rheumatoid-arthritis-during-anti-interleukin-5-therapy--peer-reviewed-fulltext-article-JAAhttps://doaj.org/toc/1178-6965Hiroki 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, benralizumabKawabata HSatoh MYatera KDove Medical Pressarticleasthmachronic eosinophilic pneumoniarheumatoid arthritismepolizumabbenralizumabImmunologic diseases. AllergyRC581-607ENJournal of Asthma and Allergy, Vol Volume 14, Pp 1425-1430 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	asthma chronic eosinophilic pneumonia rheumatoid arthritis mepolizumab benralizumab Immunologic diseases. Allergy RC581-607
spellingShingle	asthma chronic eosinophilic pneumonia rheumatoid arthritis mepolizumab benralizumab Immunologic diseases. Allergy RC581-607 Kawabata H Satoh M Yatera K Development of Rheumatoid Arthritis During Anti-Interleukin-5 Therapy in a Patient with Refractory Chronic Eosinophilic Pneumonia
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
format	article
author	Kawabata H Satoh M Yatera K
author_facet	Kawabata H Satoh M Yatera K
author_sort	Kawabata H
title	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_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_sort	development of rheumatoid arthritis during anti-interleukin-5 therapy in a patient with refractory chronic eosinophilic pneumonia
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/71c31f0fde8d4774bda86c2ad39f287c
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_version_	1718410530029305856

Development of Rheumatoid Arthritis During Anti-Interleukin-5 Therapy in a Patient with Refractory Chronic Eosinophilic Pneumonia

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