Practical Management of Respiratory Comorbidities in Patients with Rheumatoid Arthritis

Abstract

Lung disease is one of the most common causes of extra-articular morbidity and mortality in patients with rheumatoid arthritis (RA). Development of pulmonary manifestations may be due to the systemic disease itself; to serious respiratory adverse events such as pneumonitis and infections secondary to therapy; or to lifestyle habits such as smoking. Rheumatologists often need to make important treatment decisions and plan future care in RA patients with respiratory comorbidities, despite the absence of clear evidence or consensus. In this review we evaluate the clinical assessment and management of RA-associated interstitial lung disease, bronchiectasis, serious (including opportunistic) infection, and smoking-related diseases. We summarize the international recommendations for the management of such conditions where available, refer to published best practice on the basis of scientific literature, and propose practical management suggestions to aid informed decision-making.

Frequency of Hospitalized Infections Is Reduced in Rheumatoid Arthritis Patients Who Received Biological and Targeted Synthetic Disease-Modifying Antirheumatic Drugs after 2010

“…Male gender ( p = 0.0186), older age at the initiation of bDMARD/tsDMARD treatment ( p = 0.0025), higher disease activity (DAS28-CRP; p = 0.0237, DAS28-ESR; p = 0.0397), and the coexistence of diabetes mellitus ( p = 0.0245) were seen more often in the presence of chronic lung disease compared to the absence of chronic lung disease. These results are consistent with previous reports [ 23 ]. A study of 149 RA patients (mean age 68.0 years; 68 men, 81 women) with pulmonary infections revealed the coexistence of chronic airway lesions with Pseudomonas aeruginosa in all exacerbations of bronchiectasis [ 24 ].…”

Pharmacological management of progressive-fibrosing interstitial lung diseases: a review of the current evidence

“…Rheumatoid arthritis-ILD The management of patients with rheumatoid arthritis associated-ILD (RA-ILD) continues to be a challenge, particularly as there are no international guidelines on the management of this specific disease manifestation [40]. A number of therapeutic agents such as corticosteroids in combination with other immunosuppressive agents have been suggested as being effective, but no large randomised controlled trials have been undertaken to guide clinical management of this disease complication [40][41][42]. Treatment options for RA-ILD are further complicated by commonly prescribed drugs of proven articular benefit including methotrexate, leflunomide and anti-TNF-α agents, being implicated in ex novo occurrence and acceleration of existing ILDs [41].…”

“…Rituximab and abatacept have been suggested as acceptable therapeutic choices for patients with RA-ILD; however, randomised studies are warranted to confirm these findings [43,44]. Pirfenidone, which has proven efficacy in patients with IPF, is currently under investigation as a therapeutic option for patients with RA-ILD (ClinicalTrials.gov identifier: NCT02808871) [40,45].…”

Lower respiratory tract infections in rheumatic diseases

“…Как указано в рекомендациях экспертов EULAR, вакцинация против гриппа и пневмококковой инфекции настоятельно рекомендуется всем больным с аутоиммунными воспалительными РЗ, поскольку у них риск летального исхода от ИНДП достаточно высок [57]. По возможности иммунизацию указанными вакцинами проводят до назначения ГИБП [58]. Однако вакцинацию следует применять даже в случаях с ожидаемым субоптимальным ответом [59].…”