{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T23:54:45Z","timestamp":1783036485344,"version":"3.54.6"},"reference-count":43,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T00:00:00Z","timestamp":1699228800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Insufficient evidence exists regarding the efficacy of Janus kinase inhibitors (JAKis), a class of targeted synthetic disease-modifying anti-rheumatic drugs (tsDMARDs), in the treatment of rheumatoid arthritis (RA)-associated interstitial lung disease (ILD). Herein, we present a case of RA-ILD refractory to previous treatments that exhibited favorable response to upadacitinib. A 69-year-old man, former smoker, was diagnosed with RA-ILD based on persistent symmetric polyarthritis, elevated C-reactive protein levels and erythrocyte sedimentation rate, reduced diffusing capacity for carbon monoxide\/alveolar volume (DLCO 69.9%), and bilateral ground-glass attenuation with traction bronchiectasis, predominantly in the lower lung lobe. Initial treatment with oral prednisolone and methotrexate was started; however, the patient showed worsening dyspnea, chest high-resolution computed tomography abnormalities, and decreased pulmonary function. The dose of prednisolone was increased, and methotrexate was shifted to tacrolimus; however, tacrolimus was eventually discontinued because of renal dysfunction. Subsequent treatment changes included abatacept followed by intravenous cyclophosphamide, but ILD activity continued to worsen and met the criteria of progressive pulmonary fibrosis. Approximately 4.5 years after the RA diagnosis, dyspnea, radiological abnormalities, and DLCO improved following treatment switch to upadacitinib, one of JAKis. JAKi therapy may have potential as a treatment option for refractory RA-ILD.<\/jats:p>","DOI":"10.3390\/medicina59111960","type":"journal-article","created":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T08:15:56Z","timestamp":1699258556000},"page":"1960","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Successful Treatment of a Patient with Drug-Refractory Rheumatoid Arthritis-Associated Interstitial Lung Disease with Upadacitinib: A Case Report"],"prefix":"10.3390","volume":"59","author":[{"given":"Yuuya","family":"Nishii","sequence":"first","affiliation":[{"name":"Department of Respirology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan"},{"name":"Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9298-3504","authenticated-orcid":false,"given":"Masaki","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Department of Respirology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan"},{"name":"Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2274-4599","authenticated-orcid":false,"given":"Yoshiaki","family":"Zaizen","sequence":"additional","affiliation":[{"name":"Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Kojima","sequence":"additional","affiliation":[{"name":"Department of Respirology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan"},{"name":"Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Nouno","sequence":"additional","affiliation":[{"name":"Department of Respirology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan"},{"name":"Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiko","family":"Naitou-Nishida","sequence":"additional","affiliation":[{"name":"Department of Respirology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan"},{"name":"Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norikazu","family":"Matsuo","sequence":"additional","affiliation":[{"name":"Department of Respirology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan"},{"name":"Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Takeoka","sequence":"additional","affiliation":[{"name":"Department of Respirology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan"},{"name":"Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motoko","family":"Ishida","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Rheumatology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masataka","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Rheumatology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toru","family":"Masuda","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Rheumatology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takafumi","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Rheumatology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoya","family":"Miyamura","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Rheumatology, NHO Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-0065, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoaki","family":"Hoshino","sequence":"additional","affiliation":[{"name":"Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, 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J. Rheumatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s13075-023-03024-8","article-title":"Clinical characteristics of rheumatoid arthritis patients with interstitial lung disease: Baseline data of a single-center prospective cohort","volume":"25","author":"Kim","year":"2023","journal-title":"Arthritis Res. Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e17088","DOI":"10.1097\/MD.0000000000017088","article-title":"High-resolution computed tomography of the lung in patients with rheumatoid arthritis: Prevalence of interstitial lung disease involvement and determinants of abnormalities","volume":"98","author":"Salaffi","year":"2019","journal-title":"Medicine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1002\/art.27405","article-title":"Incidence and mortality of interstitial lung disease in rheumatoid arthritis: A population-based study","volume":"62","author":"Bongartz","year":"2010","journal-title":"Arthritis Rheum."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1093\/rheumatology\/keq035","article-title":"Interstitial lung disease has a poor prognosis in rheumatoid arthritis: Results from an inception cohort","volume":"49","author":"Koduri","year":"2010","journal-title":"Rheumatology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/j.resinv.2021.04.011","article-title":"2020 guide for the diagnosis and treatment of interstitial lung disease associated with connective tissue disease","volume":"59","author":"Kondoh","year":"2021","journal-title":"Respir. Investig."},{"key":"ref_8","first-page":"158","article-title":"Rheumatoid arthritis associated interstitial lung disease: A review","volume":"74","author":"Assayag","year":"2014","journal-title":"Medicina"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Yamakawa, H., Ogura, T., Kameda, H., Kishaba, T., Iwasawa, T., Takemura, T., and Kuwano, K. (2021). Decision-Making Strategy for the Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD). J. Clin. Med., 10.","DOI":"10.3390\/jcm10173806"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Cassone, G., Manfredi, A., Vacchi, C., Luppi, F., Coppi, F., Salvarani, C., and Sebastiani, M. (2020). Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease: Lights and Shadows. J. Clin. Med., 9.","DOI":"10.3390\/jcm9041082"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1002\/acr.24596","article-title":"2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis","volume":"73","author":"Fraenkel","year":"2021","journal-title":"Arthritis Care Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1111\/resp.13365","article-title":"Multidimensional improvement in connective tissue disease-associated interstitial lung disease: Two courses of pulse dose methylprednisolone followed by low-dose prednisone and tacrolimus","volume":"23","author":"Yamano","year":"2018","journal-title":"Respirology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.1056\/NEJMoa1908681","article-title":"INBUILD Trial Investigators. Nintedanib in Progressive Fibrosing Interstitial Lung Diseases","volume":"381","author":"Flaherty","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1164\/rccm.202202-0399ST","article-title":"Idiopathic Pulmonary Fibrosis (an Update) and Progressive Pulmonary Fibrosis in Adults: An Official ATS\/ERS\/JRS\/ALAT Clinical Practice Guideline","volume":"205","author":"Raghu","year":"2022","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/S2213-2600(22)00260-0","article-title":"Safety, tolerability, and efficacy of pirfenidone in patients with rheumatoid arthritis-associated interstitial lung disease: A randomised, double-blind, placebo-controlled, phase 2 study","volume":"11","author":"Solomon","year":"2023","journal-title":"Lancet Respir. Med."},{"key":"ref_16","first-page":"155","article-title":"Up-to-date information on rheumatoid arthritis-associated interstitial lung disease","volume":"9","author":"Suda","year":"2016","journal-title":"Clin. Med. Insights Circ. Respir. Pulm. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1034\/j.1399-3003.2000.15b25.x","article-title":"Methotrexate pneumonitid: Review of the literature and histopathological findings in nine patients","volume":"15","author":"Imokawa","year":"2000","journal-title":"Eur. Respir. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1002\/acr.21666","article-title":"Time-dependent increased risk for serious infection from continuous use of tumor necrosis factor antagonists over three years in patients with rheumatoid arthritis","volume":"64","author":"Sakai","year":"2012","journal-title":"Arthritis Care Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2000337","DOI":"10.1183\/13993003.00337-2020","article-title":"Methotrexate and rheumatoid arthritis associated interstitial lung disease","volume":"57","author":"Juge","year":"2021","journal-title":"Eur. Respir. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1513\/AnnalsATS.201807-443OC","article-title":"Computed tomography honeycombing identifies a progressive fibrotic phenotype with increased mortality across diverse interstitial lung diseases","volume":"16","author":"Adegunsoye","year":"2019","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/j.chest.2022.11.035","article-title":"A Real-World, Multisite Study of the Impact of Immunosuppression on Pulmonary Function Trajectory","volume":"163","author":"Matson","year":"2023","journal-title":"Chest"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Mena-V\u00e1zquez, N., Rojas-Gimenez, M., Romero-Barco, C.M., Manrique-Arija, S., Francisco, E., Aguilar-Hurtado, M.C., A\u00f1\u00f3n-O\u00f1ate, I., P\u00e9rez-Albaladejo, L., Ortega-Castro, R., and Godoy-Navarrete, F.J. (2021). Predictors of Progression and Mortality in Patients with Prevalent Rheumatoid Arthritis and Interstitial Lung Disease: A Prospective Cohort Study. J. Clin. Med., 10.","DOI":"10.3390\/jcm10040874"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1007\/s00296-016-3478-3","article-title":"Association of disease activity with acute exacerbation of interstitial lung disease during tocilizumab treatment in patients with rheumatoid arthritis: A retrospective, case-control study","volume":"36","year":"2016","journal-title":"Rheumatol. Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S2213-2600(22)00359-9","article-title":"Rituximab versus intravenous cyclophosphamide in patients with connective tissue disease-associated interstitial lung disease in the UK (RECITAL): A double-blind, double-dummy, randomised, controlled, phase 2b trial","volume":"11","author":"Maher","year":"2023","journal-title":"Lancet Respir. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"4364","DOI":"10.1093\/rheumatology\/keac023","article-title":"Predictors of rituximab effect on modified Rodnan skin score in systemic sclerosis: A machine-learning analysis of the DesiReS trial","volume":"61","author":"Ebata","year":"2022","journal-title":"Rheumatology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1016\/S2213-2600(20)30318-0","article-title":"Tocilizumab in systemic sclerosis: A randomised, double-blind, placebo-controlled, phase 3 trial","volume":"8","author":"Khanna","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_27","first-page":"33","article-title":"JAK inhibitors for rheumatoid arthritis","volume":"323","author":"Kubo","year":"2023","journal-title":"Expert. Opin. Investig. Drugs."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"991","DOI":"10.2147\/DDDT.S353494","article-title":"Therapeutic Potential of Janus Kinase Inhibitors for the Management of Interstitial Lung Disease","volume":"16","author":"Huo","year":"2022","journal-title":"Drug Des. Dev. Ther."},{"key":"ref_29","first-page":"442","article-title":"Effects of matrine on JAK-STAT signaling transduction pathways in bleomycin-induced pulmonary fibrosis","volume":"10","author":"Ma","year":"2013","journal-title":"Afr. J. Tradit. Complement. Altern. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s12931-018-0728-9","article-title":"The JAK2 pathway is activated in idiopathic pulmonary fibrosis","volume":"19","author":"Milara","year":"2018","journal-title":"Respir. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1186\/s13075-019-1963-2","article-title":"Tofacitinib facilitates the expansion of myeloid-derived suppressor cells and ameliorates interstitial lung disease in SKG mice","volume":"21","author":"Sendo","year":"2019","journal-title":"Arthritis Res. Ther."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e233640","DOI":"10.1001\/jamanetworkopen.2023.3640","article-title":"Incidence of Interstitial Lung Disease in Patients with Rheumatoid Arthritis Treated With Biologic and Targeted Synthetic Disease-Modifying Antirheumatic Drugs","volume":"6","author":"Baker","year":"2023","journal-title":"JAMA Netw. Open."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1069486","DOI":"10.3389\/fmed.2022.1069486","article-title":"Radiomics to predict the mortality of patients with rheumatoid arthritis-associated interstitial lung disease: A proof-of-concept study","volume":"9","author":"Venerito","year":"2023","journal-title":"Front. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"106748","DOI":"10.1016\/j.intimp.2020.106748","article-title":"Efficacy of baricitinib in treating rheumatoid arthritis: Modulatory effects on fibrotic and inflammatory biomarkers in a real-life setting","volume":"86","author":"Perillo","year":"2020","journal-title":"Int. Immunopharmacol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"6652845","DOI":"10.1155\/2021\/6652845","article-title":"Tofacitinib for the Treatment of Severe Interstitial Lung Disease Related to Rheumatoid Arthritis","volume":"2021","author":"Vacchi","year":"2021","journal-title":"Case Rep. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2569","DOI":"10.1002\/art.27584","article-title":"2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology\/European League Against Rheumatism collaborative initiative","volume":"62","author":"Aletaha","year":"2010","journal-title":"Arthritis Rheum."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1164\/rccm.2009-040GL","article-title":"An official ATS\/ERS\/JRS\/ALAT statement: Idiopathic pulmonary fibrosis: Evidence-based guidelines for diagnosis and management","volume":"183","author":"Raghu","year":"2011","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1002\/acr2.11171","article-title":"DAS28-CRP Cutoffs for High Disease Activity and Remission Are Lower Than DAS28-ESR in Rheumatoid Arthritis","volume":"2","author":"Greenmyer","year":"2020","journal-title":"ACR Open Rheumatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2114","DOI":"10.1093\/rheumatology\/key188","article-title":"Tofacitinib for refractory interstitial lung diseases in anti-melanoma differentiation-associated 5 gene antibody-positive dermatomyositis","volume":"57","author":"Kurasawa","year":"2018","journal-title":"Rheumatology"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1007\/s00393-018-0565-8","article-title":"Ansprechen einer Dermatomyositis mit Lungenbeteiligung auf eine Januskinase-Inhibitor-Therapie [Response of dermatomyositis with lung involvement to Janus kinase inhibitor treatment]","volume":"77","author":"Hornig","year":"2018","journal-title":"Z. Rheumatol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1056\/NEJMc1900045","article-title":"Tofacitinib in Amyopathic Dermatomyositis-Associated Interstitial Lung Disease","volume":"381","author":"Chen","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1002\/art.41580","article-title":"Venous Thromboembolism Risk with JAK Inhibitors: A Meta-Analysis","volume":"73","author":"Yates","year":"2021","journal-title":"Arthritis Rheumatol."},{"key":"ref_43","unstructured":"(2023, September 08). European Medicines Agency Science Medicines Health Website. Available online: https:\/\/www.ema.europa.eu\/en\/medicines\/human\/referrals\/janus-kinase-inhibitors-jaki#key-facts-section."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/11\/1960\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:18:21Z","timestamp":1760131101000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/11\/1960"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,6]]},"references-count":43,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["medicina59111960"],"URL":"https:\/\/doi.org\/10.3390\/medicina59111960","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,6]]}}}