Treatment with biologic DMARDs may not adversely affect lung nodules in rheumatoid arthritis patients

Objective: Lung nodules (LNs) impose diagnostic and therapeutic challenges in patients with rheumatoid arthritis (RA) due to unpredictable outcomes. Potential induction of nodulosis with the use of conventional synthetic DMARDs (csDMARD) and lack of knowledge regarding the effect of biologic disease-modifying anti-rheumatic drugs (bDMARDs)/tofacitinib on the LN raise concerns and have an impact on treatment decisions. This study aims to evaluate the possible effects of the bDMARDs/tofacitinib and csDMARDS on LNs observed in RA patients. Methods: Electronic health records of RA patients who had LNs detected on computed tomography (CT) between January 2015 and December 2020 were evaluated retrospectively. Patients with follow-up CT images were included in the study. Baseline and follow-up images were meticulously examined for the number, size, attenuation, and cavity formation. Clinical, histopathologic, and laboratory findings were analyzed. Results: Forty-two RA patients with LNs were studied, 21 were on bDMARDs/tofacitinib (11 females, mean age: 59.7 +/- 8.4) and 21 were on csDMARDs (12 females, mean age: 71.4 +/- 8.3). The proportion of patients with progressed nodules during follow-up was comparable between groups (six patients in bDMARDs/tofacitinib vs seven patients in csDMARDs). Progression of LNs was observed in six patients in the bDMARDs/tofacitinib group: three in anti-TNFa, two in rituximab, and one in abatacept users and none in tofacitinib users. Conclusion: Our results suggest that the risk of progression in LNs in RA patients with use of bDMARDs/tofacitinib might not impose a higher risk compared to csDMARDs. Moreover, bDMARDs/tofacitinib might result in regression in LNs.