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Arthritis and Rheumatism

Taking Enbrel For Rheumatoid Arthritis While Having Pneumonia

05/20/2008

Question:

I have Rheumatoid Arthritis and have been on Methothrexate since December and am supposed to start Enbrel next week. I got very sick the first of March with Pneumonia and Pleurisy. I took Levaquin for 10 days and I still have the pain so the doctor ordered a CT scan. I have a strong family history of lung cancer in non smokers. I have been a smoker for over thirty years. This is my second bought of Pneumonia in a year and a half. Please help me with the CT scan results. FINDINGS: numerous subcentimeter lymph nodes throughout anterior mediastinum and aortopulmonary window. This is a disconcerting configuration, but I can identify no definate lymph node of significant size. No significant pleural or pericardial fluid. A small amount of interstitial scarring is noted in the left lung base posteriorly. There is a density just behind the aorta which represents the superior pericardial recess and does not constitute a lymph node. Left adrenal gland is slightly generous in size but no adrenal mass is seen. On lung windows there is a non consolidating interstitial infiltrate in the mid portion of the left lower lobe posteriorly, acute versus chronic, mild thickening of the bronchial mucosa bilaterally. OPINION: Chronic change as described above including numerous subcentimeter lymph nodes in the anterior mediastinum and aortapulmonary window as described. No significant lymphadenopathy is identified, but there are no previous exams for comparison. Non-consolidating interstitial infiltrate in the mid portion of the left lower lobe posteriorly, acute versus chronic and follow-up of this area is recommended. There is no previous exam for comparision. I also had a thyroid ultrasound done the same day which revealed inhomogeneous echogenicity with multiple small solid nodules scattered throughout both lobes of the thyroid gland. A nuclear medicine thyroid scan might be helpful to evaluate for the possibility of a solitary cold nodule. My doctor has not yet called me with these results, my tests were last week. I went to the hospital and got these myself yesterday and my doctor says they do not have the results back. I am very concerned about receiving the Methothrexate injections as well as beginning the Enbrel next week with these findings. Please help me! Should I be worried? Does the fact that the doctor did a lupus blood test have anything to do with these findings? The blood tests all came back as normal, no elevated ANA or DNA double strand, although she suspects lupus because of the symptoms all add up to it.

Answer:

Thank your for your interest in the NetWellness website. My advice is to discuss these same concerns with your treating physician. As you mentioned in your post, your physician has not yet received the results and has not yet had the opportunity to discuss their plan of action with you. Recognize that starting a new medicine, in your case etanercept (Enbrel), is based on a personalized benefit-to-risk analysis. If I were to focus your concerns, I would discuss the following with your physician:

Given my history of pneumonia, does the benefit of starting Enbrel to treat my rheumatoid arthritis (RA) outweigh the increased risk of infection?

Are the finding on my chest CT representative of: 1) reactive changes due to RA, 2) infection, 3) medicines, or 4) something else?

If I start Enbrel, will there be a need to monitor over time the current findings of my chest CT?

For more information:

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Response by:

Raymond  Hong, MD, MBA, FACR Raymond Hong, MD, MBA, FACR
Formerly, Assistant Professor of Medicine
School of Medicine
Case Western Reserve University