Rheumatoid Arthritis (RA) combined with characteristics of Pulmonary Lymphomatoid Granulomatosis (PLG) is a rare lung disorder with multiple nodular lesions with lymphocytic invasion of vascular walls. A new study entitled “Rituximab for pulmonary lymphomatoid granulomatosis which developed as a complication of methotrexate and azathioprine therapy for rheumatoid arthritis” was published in SpringerPlus by Athar Barakat from the group of Dr. Rohit Peshin at the Department of Rheumatology, Nobles Hospital, Isle of Man, UK highlighting a new treatment option for the rare complication.
Pulmonary Lymphomatoid Granulomatosis condition is a rare lymphoproliferative disorder primarily affecting the lung and with variable clinical outcomes, but can include other conditions like autoimmunity, immunodeficiency, infection mostly by Epstein-Barr virus and malignancy. This disease can be secondary to immunosuppressive medications such as azathioprine, methotrexate, and imatinib where the disorder resolves after discontinuing medications. Pulmonary lymphomatoid granulomatosis occurs normally in patients between 30 and 50 years old, although people can be affected at any age. It is more frequently seen in men, with an estimated male to female ratio of 2 to 1. The relevance of race and geography on disease frequency are not known, however a higher incidence rate has been reported in Western countries.
In this study, the researchers presented a rare case of a patient with Rheumatoid Arthritis [RA] with clinical, pathological and radiological characteristics of Pulmonary Lymphomatoid Granulomatosis (PLG). The authors analyzed the case of PLG condition due to the use of conventional immunosuppressive agents, Methotrexate and Azathioprine, which was then effectively treated with Steroids and Rituximab, a chimeric monoclonal antibody. They emphasized the relevance of lung biopsy in the diagnosis and the use of rituximab as an alternative therapy for RA as well as PLG.
This is the first case report of the use of Rituximab in treatment of PLG which had developed as a complication of Disease-modifying antirheumatic drugs (DMARDs) therapy in a patient with RA.
