Non-steroidal anti-inflammatory drugs and drug-induced pulmonary alveolitis

Many reports attributing diffuse radiographic shadows to non-steroidal anti-inflammatory drug (NSAIO) treatment have appeared since 1971. The drugs involved in the reports include azapropazone, indomethacin, benoxaprofen, naproxen, piroxicam, phenylbutazone, oxyphenbutazone, diclofenac, ibuprofen and sulindac. Although individual examination of adverse reaction case reports cannot fully establish that a particular drug causes the reaction, shared features, possibly representative of a clinical syndrome (drug-induced pulmonary alveolitis), are described in these reports. The essential features of this syndrome, which have been observed in patients with rheumatoid arthritis, osteoarthritis and psoriatic arthropathy, include the sudden onset of pulmonary symptoms resistant to antibacterials; radiographic changes; and rapid clinical improvement after NSAIO withdrawal.

Thus, although rare, drug-induced pulmonary alveolitis should be suspected when a clinical illness suggestive of pulmonary infection develops accompanied by the absence of a response to antibacterials in patients receiving NSAIO treatment. Weber JCP, Essigman WK. British Journal of Rheumatology 25: 5·6, Feb 1986

2 Reactions'" 26 April 1986 0157-7271/86/1026-0002/0$01.00/0 © ADIS Press