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Disease-modifying antirheumatic drugs and organising pneumonia
  1. Mohamed Faisal,
  2. Asyraf Roslan,
  3. Nik Nuratiqah Nik Abeed and
  4. Andrea Ban Yu-Lin
  1. Respiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
  1. Correspondence to Dr Andrea Ban Yu-Lin; andreaban{at}


Organising pneumonia (OP) in rheumatoid arthritis (RA) may be part of pulmonary manifestation (disease related) or disease-modifying antirheumatic drugs (DMARDs) related. We report a case series of RA patients with DMARDs related OP. A 65-year-old woman developed OP 3 weeks after initiation of methotrexate (MTX). High-resolution CT (HRCT) scan of the thorax revealed bilateral consolidations in the lung bases. She had complete radiological resolution 6 months after corticosteroid therapy with cessation of MTX. The second case was of a 60-year-old woman on MTX with recent addition of leflunomide due to flare of RA. She developed worsening cough 4 months later and HRCT scan revealed consolidation in the left upper lobe with biopsy proven OP. She responded within 6 months of corticosteroid therapy with clinical and radiological resolution. This case series highlights that OP may developed with low-dose MTX (as early as 3 weeks) and leflunomide and the diagnosis requires a high index of suspicion.

  • interstitial lung disease
  • respiratory medicine
  • rheumatoid arthritis
  • rheumatology

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  • Contributors MF, AR and NNNA were involved in the conception of the case report, review of literature and writing the manuscript. MF and ABY-L revised this case report and contributed to important intellectual content. All authors participated and approved the final revision of the manuscript and are accountable for the accuracy of the content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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