Acute exacerbation of rheumatoid arthritis-associated interstitial lung disease triggered by COVID-19: What is the best practice for treatment?

Toshiyuki Yonezawa; Atsushi Suzuki; Kensuke Fukumitsu; Takuma Katano; Hisashi Kako; Makoto Ishii; Akio Niimi; Kazuyoshi Imaizumi; Koji Sakamoto; Norihito Omote; Etsuro Yamaguchi

doi:10.1016/j.rmcr.2023.101857

Acute exacerbation of rheumatoid arthritis-associated interstitial lung disease triggered by COVID-19: What is the best practice for treatment?

Respir Med Case Rep. 2023:43:101857. doi: 10.1016/j.rmcr.2023.101857. Epub 2023 Apr 25.

Authors

Toshiyuki Yonezawa^{1

2}, Atsushi Suzuki^{2

3}, Kensuke Fukumitsu^{2

4}, Takuma Katano^{1

2}, Hisashi Kako^{2

5}, Makoto Ishii³, Akio Niimi⁴, Kazuyoshi Imaizumi⁵, Koji Sakamoto³, Norihito Omote³, Etsuro Yamaguchi^{1

2}

Affiliations

¹ Department of Respiratory Medicine and Allergology, Aichi Medical University, Nagakute, Aichi, Japan.
² Department of Internal Medicine, Aichi Prefectural Hospital, Okazaki, Aichi, Japan.
³ Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
⁴ Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
⁵ Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.

Abstract

We present a case of 79-year-old female with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) developed an acute exacerbation (AE) triggered by coronavirus disease 2019 (COVID-19). The patient was unresponsive to a combination therapy of remdesivir, dexamethasone, and tocilizumab. Given that a recent multicenter cohort study reported ILD as a poor prognostic contributor in patients with RA and COVID-19, there may be potentially a certain number of patients with AE of RA-ILD triggered by COVID-19. This case highlights the need for a discussion how to treat these patients in a daily clinical practice.

Keywords: Acute exacerbation; COVID-19; Interstitial lung diseases; Rheumatoid arthritis; Treatment.

Publication types

Case Reports