Interstitial Lung Disease in Rheumatoid Arthritis: A Practical Review

Abstract

Rheumatoid arthritis (RA) is a systemic inflammatory disease, which primarily causes symmetric polyarthritis. An extrarticolar involvement is common, and the commonly involved organ is lungs. Although cardiac disease is responsible for most RA-related deaths, pulmonary disease is also a major contributor, accounting for ~10–20% of all mortality. Pulmonary disease is a common (60–80% of patients with RA) extra-articular complication of RA. Optimal screening, diagnostic, and treatment strategies of pulmonary disease remain uncertain, which have been the focus of an ongoing investigation. Clinicians should regularly assess patients with RA for the signs and symptoms of pulmonary disease and, reciprocally, consider RA and other connective tissue diseases when evaluating a patient with pulmonary disease of an unknown etiology. RA directly affects all anatomic compartments of the thorax, including the lung parenchyma, large and small airways, pleura, and less commonly vessels. In addition, pulmonary infection and drug-induced lung disease associated with immunosuppressive agents used for the treatment of RA may occur.

Potential Role of JAK Inhibitors in the Treatment of Systemic Sclerosis-Associated Interstitial Lung Disease: A Narrative Review from Pathogenesis to Real-Life Data

“…Interestingly, more data are available on JAKinibs efficacy in RA-associated ILD and they confirm what we detected in SSc [45]. A recent retrospective study [46] evaluated 75 RA patients comparing JAKinibs efficacy with ABA: 31 patients received treatment with a JAKinibs (18 were treated with baricitinib, 13 with tofacitinib) and RA-ILD progression was seen in 5 of them (16.1%), stability in 20 (64.5%), and improvement in 6 (19.4%).…”

Evolution of Rheumatoid-Arthritis-Associated Interstitial Lung Disease in Patients Treated with JAK Inhibitors: A Retrospective Exploratory Study

“…Several authors described a possible effect of all TNFi in the new onset or exacerbation of RA-ILD [11][12][13]. Perez-Alvarez et al and the British Society of Rheumatology have historically cautioned against prescribing TNFi to patients with RA-ILD for the supposed increased risk of exacerbation of ILD [13,14].…”

Danggui Niantong Decoction ameliorates joint inflammation and cardiopulmonary injury in TNF-Tg mice

“…Systemic complications of RA include interstitial lung disease (ILD), cardiovascular disease, sarcopenia, autoimmune liver disease, and cognitive dysfunction [2] . ILD and cardiovascular disease are the two leading causes of death in RA [3][4][5] . RA affects approximately 0.5% to 1% of the global population [6][7] .…”

“…The drugs commonly used clinically to treat RA include nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), glucocorticoids, and anti-tumor necrosis factor (TNF)-alpha agents [1] . Although these drugs have shown improved efficacy in the joint manifestations of RA, their role in alleviating cardiopulmonary complications is limited, and some may cause or exacerbate cardiopulmonary complications such as lung infection [5] , hypertension [13] , and myocardial infarction [14] . For example, methotrexate (MTX), the most widely used initial DMARD monotherapy or combination therapy for RA, causes pulmonary function limitations and toxicity [15] .…”