Rheumatoid Arthritis–Associated Interstitial Lung Disease: Current Update on Prevalence, Risk Factors, and Pharmacologic Treatment

Huang, Sicong; Kronzer, Vanessa L.; Dellaripa, Paul F.; Deane, Kevin D.; Bolster, Marcy B.; Nagaraja, Vivek; Khanna, Dinesh; Doyle, Tracy J.; Sparks, Jeffrey A.

doi:10.1007/s40674-020-00160-z

Cited by 38 publications

(33 citation statements)

References 96 publications

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“…If the response to corticosteroid therapy is poor, the administration of other immunosuppressive agents such as cyclophosphamide (CYC), cyclosporine A, and tacrolimus should be considered, which has the potential to improve the prognosis of the AE of RA-ILD [17]. The presence of AE of RA-ILD indicates an extremely poor condition with high mortality (64%) [2,4,5], and thus, this serious condition needs to be carefully considered.…”

Section: Therapeutic Assessment Of Acute/subacute Ra-ild Showing a Wide Variety Of Bilateral Pulmonary Shadowsmentioning

confidence: 99%

“…About half of the patients develop ILD either before or within 5 years of the RA diagnosis [18]. Some studies identified prevalence estimates ranging from 2 to 8% in RA patients [2], whereas the estimated prevalence based on HRCT analysis is reported at a relatively higher range of 27-67% [19][20][21][22][23][24][25][26][27]. Most cases are diagnosed as being asymptomatic, with 7-29% having clinical symptoms [24][25][26][27].…”

Section: Prevalence and Clinical Manifestationsmentioning

confidence: 99%

“…The prevalence of RA-associated interstitial lung disease (RA-ILD) ranges widely in the literature, likely due to varying methodologies used in its detection. Some studies identified RA-ILD through clinical detection, with prevalence estimates ranging from 2 to 8% in RA patients [2]. The most common reasons for death in RA patients in Japan are both respiratory disease and malignancy [3].…”

Section: Introductionmentioning

confidence: 99%

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Decision-Making Strategy for the Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD)

Yamakawa

Ogura

Kameda

et al. 2021

JCM

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Rheumatoid arthritis (RA) is a common type of autoimmune arthritis. Patient clinical outcomes might be influenced by numerous respiratory diseases, but interstitial lung disease (ILD) is the most important comorbidity. RA-associated ILD (RA-ILD) is divided into acute/subacute and chronic forms. In the acute/subacute course, if the disease is severe as indicated by a diffuse alveolar damage pattern, high-dose corticosteroids combined with antimicrobial agents should be promptly initiated while considering the differential diagnoses, primarily acute exacerbation (AE) of RA-ILD, drug-induced pneumonitis, and Pneumocystis pneumonia. As initial therapeutic management in the chronic course, the RA itself should be stabilized without delay; thereafter, the activity of ILD itself can be stabilized, considering the safety of each anti-rheumatic drug. The formation of the usual interstitial pneumonia (UIP) pattern is the most important determinant because lung function can worsen more quickly with this pattern. However, because clinicians can fail to identify specific radiological patterns, it is important to determine whether each patient with RA-ILD has UIP-like lesions such as subpleural reticulation, traction bronchiectasis, and honeycombing especially progressively enlarged cysts. In patients with progressive RA-ILD and high risk for infection or AE of ILD in whom fibrosis is dominant, clinicians should consider starting an anti-fibrotic agent.

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Section: Therapeutic Assessment Of Acute/subacute Ra-ild Showing a Wide Variety Of Bilateral Pulmonary Shadowsmentioning

confidence: 99%

Section: Prevalence and Clinical Manifestationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Decision-Making Strategy for the Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD)

Yamakawa

Ogura

Kameda

et al. 2021

JCM

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“…Pulmonary disease also can develop later. It is one of the extra-articular manifestations of RA and a major factor in mortality [ 98 , 99 ]. Therefore, understanding the molecular basis of how cadmium initiates RA will provide further insights into the role of metal ions in the disease.…”

Section: Zinc and Cadmium In The Aetiology And As Risk Factors Of mentioning

confidence: 99%

Zinc and Cadmium in the Aetiology and Pathogenesis of Osteoarthritis and Rheumatoid Arthritis

Frangos

Maret

2020

Nutrients

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Osteoarthritis (OA) and rheumatoid arthritis (RA) are inflammatory articular conditions with different aetiology, but both result in joint damage. The nutritionally essential metal zinc (Zn2+) and the non-essential metal cadmium (Cd2+) have roles in these arthritic diseases as effectors of the immune system, inflammation, and metabolism. Despite both metal ions being redox-inert in biology, they affect the redox balance. It has been known for decades that zinc decreases in the blood of RA patients. It is largely unknown, however, whether this change is only a manifestation of an acute phase response in inflammation or relates to altered availability of zinc in tissues and consequently requires changes of zinc in the diet. As a cofactor in over 3000 human proteins and as a signaling ion, zinc affects many pathways relevant for arthritic disease. How it affects the diseases is not just a question of zinc status, but also an issue of mutations in the many proteins that maintain cellular zinc homoeostasis, such as zinc transporters of the ZIP (Zrt-/Irt-like protein) and ZnT families and metallothioneins, and the multiple pathways that change the expression of these proteins. Cadmium interferes with zinc’s functions and there is increased uptake under zinc deficiency. Remarkably, cadmium exposure through inhalation is now recognized in the activation of macrophages to a pro-inflammatory state and suggested as a trigger of a specific form of nodular RA. Here, we discuss how these metal ions participate in the genetic, metabolic, and environmental factors that lead to joint destruction. We conclude that both metal ions should be monitored routinely in arthritic disease and that there is untapped potential for prognosis and treatment.

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“… 46 – 48 No other randomized, double-blind controlled trials have demonstrated a benefit of immunosuppressant therapy in the treatment of autoimmune disease-associated ILDs, but they are widely used, 73 likely based on extrapolation from findings in patients with SSc-ILD and the findings of uncontrolled studies. High RA disease activity has been associated with increased risk of developing RA-ILD, 74 suggesting that treatment of underlying rheumatic disease may also influence ILD risk. Immunosuppressants are also frequently used to treat fibrotic HP, but in the absence of well-designed prospective randomized controlled trials, it remains unclear whether they are effective in slowing its progression.…”

Section: Management Of Fibrosing Ildsmentioning

confidence: 99%

Monitoring and management of fibrosing interstitial lung diseases: a narrative review for practicing clinicians

Nambiar¹,

Walker

2021

Ther Adv Respir Dis

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Close monitoring of patients with fibrosing interstitial lung diseases (ILDs) is important to enable prompt identification and management of progressive disease. Monitoring should involve regular assessment of physiology (including pulmonary function tests), symptoms, and, when appropriate, high-resolution computed tomography. The management of patients with fibrosing ILDs requires a multidisciplinary approach and should be individualized based on factors such as disease severity, evidence of progression, risk factors for progression, comorbidities, and the preferences of the patient. In this narrative review, we discuss how patients with fibrosing ILDs can be effectively monitored and managed in clinical practice.

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Rheumatoid Arthritis–Associated Interstitial Lung Disease: Current Update on Prevalence, Risk Factors, and Pharmacologic Treatment

Cited by 38 publications

References 96 publications

Decision-Making Strategy for the Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD)

Decision-Making Strategy for the Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD)

Zinc and Cadmium in the Aetiology and Pathogenesis of Osteoarthritis and Rheumatoid Arthritis

Monitoring and management of fibrosing interstitial lung diseases: a narrative review for practicing clinicians

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