Journal of Asthma and Allergy (Nov 2021)
Development of Rheumatoid Arthritis During Anti-Interleukin-5 Therapy in a Patient with Refractory Chronic Eosinophilic Pneumonia
Abstract
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 [email protected]: 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
