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                <title xml:lang="en">Pulmonary nodulosis and aseptic granulomatous lung disease occurring in patients with rheumatoid arthritis receiving tumor necrosis factor-alpha-blocking agent: a case series.</title>
                <author role="aut">
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                    <forename type="first">Eric</forename>
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                    <forename type="first">Jean Marie</forename>
                    <surname>Berthelot</surname>
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                  <idno type="halauthorid">447579-0</idno>
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                    <forename type="first">Philippe</forename>
                    <surname>Gaudin</surname>
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                  <persName>
                    <forename type="first">José</forename>
                    <surname>Le Noach</surname>
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                  <idno type="halauthorid">447582-0</idno>
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                  <persName>
                    <forename type="first">Anne</forename>
                    <surname>Lohse</surname>
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                  <persName>
                    <forename type="first">Emmanuelle</forename>
                    <surname>Lecuyer</surname>
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                  <idno type="halauthorid">447584-0</idno>
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                <author role="aut">
                  <persName>
                    <forename type="first">Le</forename>
                    <surname>Cri</surname>
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                <idno type="issn">0315-162X</idno>
                <idno type="eissn">1499-2752</idno>
                <title level="j">Journal of Rheumatology</title>
                <imprint>
                  <publisher>Journal of Rheumatology Publishing Company Limited</publisher>
                  <biblScope unit="volume">36</biblScope>
                  <biblScope unit="issue">11</biblScope>
                  <biblScope unit="pp">2421-7</biblScope>
                  <date type="datePub">2009-11</date>
                  <date type="dateEpub">2009-10-01</date>
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              <classCode scheme="mesh">Aged</classCode>
              <classCode scheme="mesh">Male</classCode>
              <classCode scheme="mesh">Middle Aged</classCode>
              <classCode scheme="mesh">Receptors, Tumor Necrosis Factor</classCode>
              <classCode scheme="mesh">Treatment Outcome</classCode>
              <classCode scheme="mesh">Tumor Necrosis Factor-alpha</classCode>
              <classCode scheme="mesh">Antibodies, Monoclonal</classCode>
              <classCode scheme="mesh">Antirheumatic Agents</classCode>
              <classCode scheme="mesh">Arthritis, Rheumatoid</classCode>
              <classCode scheme="mesh">Female</classCode>
              <classCode scheme="mesh">Granuloma</classCode>
              <classCode scheme="mesh">Humans</classCode>
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              <p>OBJECTIVE: To describe cases of development of pulmonary nodulosis or aseptic granulomatous lung disease in patients with rheumatoid arthritis (RA) receiving anti-tumor necrosis factor-alpha (TNF-alpha) therapy. METHODS: A call for observation of such cases was sent to members of the French "Club Rhumatismes et Inflammation." The cases had to occur after introduction of TNF-alpha-blocking therapy. RESULTS: Eleven cases were examined: 6 patients were treated with etanercept, 2 with infliximab, and 3 with adalimumab. Pulmonary nodular lesions were observed after a mean treatment period of 23.3 +/- 15.3 months. Clinical symptoms were observed in 5 cases. Radiographs or computed tomography of the chest showed single or multiple nodular lesions in 10 cases and hilar adenopathies in 1 case. Biopsy of the nodular chest lesions or mediastinal lymphadenopathies were performed in 8 patients, and revealed typical rheumatoid nodules in 4 cases and noncaseating granulomatous lesions in 4 cases. Mycobacterial or opportunistic infections were excluded for all cases. Outcome was favorable for all the patients, with either discontinuation or maintenance of anti-TNF-alpha treatment. CONCLUSION: Aseptic pulmonary nodular inflammation corresponding to rheumatoid nodules or noncaseating granulomatous inflammation can occur during anti-TNF-alpha therapy for RA, mainly etanercept. The mechanism explaining such a reaction is not clear but certainly includes different processes. These cases of pulmonary nodular inflammation generally have a benign course and do not systematically require withdrawal of treatment.</p>
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