Radiographic changes in patients with tumor necrosis factor alpha inhibitor and immunomodulatory drug users: Four years follow up

Immunomodulatory drugs and TNF-alpha inhibitors paradoxically can lead to interstitial lung abnormalities in some cases. 40 consecutive patients were questioned and changes in chest X-ray taken in the last 4 years have been evaluated. 40 of the patients were male. The mean age was 49.5±11.7 years. The rate of patients with ankylosing spondylitis, rheumatoid arthritis and psoriasis was 50%, 35% and 15%, respectively. Average years of disease were 11.4 ± 8.9 years. The rate of infliximab, etanercept, adalimumab and golimumab presciribed to patients was 47.5%, 32.5%, 12.5%, 32.5% and 12.5% and 7.5%, respectively. According to the order of frequency of past treatment of patients, the rate with sulfasalazine, non-steroidal anti-inflammatory drugs, methotrexate, steroids, hydroxychloroquine, azathioprine, and colchicine was 2.5%. 75%, 57.5%, 30%, 27.5%, 15%, 2.5%, respectively. The use of methotrexate in combination with inhibitors of TNF-alpha was 25%. There were parenchymal abnormalities in 44.8% of patients used sulfasalazine in their first X-ray (10% of those using abnormal, p = 0.50). There was significantly more abnormal parenchymal findings in patients using methotrexate in their third radiography (85.79y% to 30.8%, p = 0.041). The mediastinal pathology detected in the first radiographic examination of patients with hydroxychloroquine and non-hydroxychloroquine users was 50% (3/6) and 9.1% (3/33), respectively (p = 0.036). Similarly, it was 20% (2/10) and 0% in methotrexate (p = 0.045). The possible chest X-ray abnormalities may develop in patients treated with immunomodulatory and underlying disease must be carefully examined.