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 rheuma- toid arthritis (RA) due to unpredictable outcomes. Potential induction of nodulosis with the use of con- ventional 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/tofa- citinib 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 find- ings were analyzed.

Results: Forty-two RA patients with LNs were studied, 21 were on bDMARDs/tofacitinib (11 females, mean age: 59.7 6 8.4) and 21 were on csDMARDs (12 females, mean age: 71.4 6 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.