Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease: Lights and Shadows

Cassone, Giulia; Manfredi, Andreina; Vacchi, Caterina; Luppi, Fabrizio; Coppi, Francesca; Salvarani, Carlo; Sebastiani, Marco

doi:10.3390/jcm9041082

Cited by 77 publications

(95 citation statements)

References 208 publications

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“…Because of the relevant role of TLR4 in pathogenesis of RA [ 21 , 23 , 51–53 , 56 ], inhibition of TLR4 has been explored as a possible therapeutic target; in experimental models, the TLR4 inhibitor TAK-242, inhibited the production of interleukin (IL)-6, IL-8, matrix metalloproteinase-1, and vascular endothelial growth factor in a LPS stimulated human synovial cell line [ 53 ].…”

Section: Pathogenesis Of Covid-19mentioning

confidence: 99%

“…Nevertheless, some biologic DMARDS have been recently associated to a more favorable evolution of RA-ILD, such as rituximab, abatacept, tocilizumab [ 51 , 59–61 ].…”

Section: Pathogenesis Of Covid-19mentioning

confidence: 99%

“…Moreover, in a retrospective cohorts of RA patients, some Authors observed a good safety and effectiveness profile of abatacept in patients complicated by ILD [ 64 , 65 ]. Finally, in a pooled analysis on more than 4000 RA patients treated with abatacept by the ‘Clinical Abatacept Trial Program’, the incidence rate of ILD in the long-extension analysis was very low [ 66 ] if compared with other similar study in RA [ 51 ].…”

Section: Pathogenesis Of Covid-19mentioning

confidence: 99%

“…Differential diagnosis of an AE-ILD in the context of a rheumatic disease includes mainly opportunistic infections, pulmonary embolism and heart failure. In this context, our multidisciplinary group actively collaborate in evaluating and treating these patients [ 51 , 60 , 61 , 70 , 116 ] (see Figure 2 ).

Figure 2.…”

Section: Expert Opinionmentioning

confidence: 99%

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Pathogenesis and treatment of idiopathic and rheumatoid arthritis-related interstitial pneumonia. The possible lesson from COVID-19 pneumonia

Manfredi

Luppi

Cassone

et al. 2020

Expert Review of Clinical Immunology

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Introduction Main clinical manifestations of SARS-CoV-2 infection are characterized by fever, dyspnea, and interstitial pneumonia, frequently evolving in acute respiratory distress syndrome (ARDS). Areas covered Features of coronavirus disease 2019 (COVID-19) presents some common points with interstitial lung disease (ILD) both idiopathic and related to rheumatoid arthritis (RA), typically characterized by a chronic progression over time and possibly complicated by acute exacerbation (AE). The study of common pathogenetic mechanisms, such as the involvement of toll-like receptor 4, could contribute to the knowledge and treatment of idiopathic and RA-ILD. Moreover, hyperinflammation, mainly characterized by increase of effector T-cells and inflammatory cytokines, and activation of coagulation cascade, observed in COVID-19 related ARDS have been already shown in patients with AE of idiopathic and RA-ILD. A literature search was performed in PubMed, Embase, Scopus, and Web of Science, together with a manual search in COVID-resource centers of the main journals. Expert opinion Despite the uncertainty about pathogenetic aspects about COVID-19- pneumonia, it could be a possible model for other forms of ILD and AE. The great amount of data from studies on COVID-19 could be helpful in proposing safe therapeutic approaches for RA-ILD, in understanding pathogenesis of usual interstitial pneumonia and to develop new therapeutic strategies for AE.

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Section: Pathogenesis Of Covid-19mentioning

confidence: 99%

“…Nevertheless, some biologic DMARDS have been recently associated to a more favorable evolution of RA-ILD, such as rituximab, abatacept, tocilizumab [ 51 , 59–61 ].…”

Section: Pathogenesis Of Covid-19mentioning

confidence: 99%

Section: Pathogenesis Of Covid-19mentioning

confidence: 99%

Figure 2.…”

Section: Expert Opinionmentioning

confidence: 99%

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Pathogenesis and treatment of idiopathic and rheumatoid arthritis-related interstitial pneumonia. The possible lesson from COVID-19 pneumonia

Manfredi

Luppi

Cassone

et al. 2020

Expert Review of Clinical Immunology

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“…В настоящее время проводится ряд клинических исследований, оценивающих эффективность и безопас- ность использования пирфенидона у пациентов с прогрессирующими фиброзирующими ИЗЛ, ССД-ИЗЛ, РА-ИЗЛ, саркоидозом и гиперчувствительным пневмонитом [33,34].…”

Section: основные направления в леченииunclassified

Interstitial lung diseases with progressive pulmonary fibrosis: pathogenetic features and approaches to therapy

2020

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A number of patients with interstitial lung diseases (ILD) of various etiologies, including hypersensitive pneumonitis, diffuse connective tissue diseases (rheumatoid arthritis, systemic scleroderma, dermatomyositis), sarcoidosis, idiopathic non-specific interstitial pneumonia (NSIP) and unclassified ILD develop rapid deterioration of lung ventilation function due to the progression of fibrotic changes, accompanied by a decrease in physical performance and quality of life. It is proposed to distinguish a progressive fibrotic phenotype from those with similar pathogenetic mechanisms, radiologic pattern, clinical course, and prognosis. The progressive course of the fibrotic process is assessed by reducing the forced vital capacity of the lungs (FVC), increasing the severity of signs of pulmonary fibrosis according to computed tomography (CT) and worsening respiratory symptoms. There are several risk factors for the progression of ILD, such as male gender, older age, lower initial pulmonary function, and radiological or pathological picture of usual interstitial pneumonia (UIP). Currently, the role of antifibrotic drugs in the treatment of this pathology is being actively studied. Previously, the common approach was to use this group of drugs in patients with idiopathic pulmonary fibrosis (IPF) and immunosuppressive drugs in patients with other fibrotic subtypes of IL. However, the results of clinical studies have shown a favorable response to antifibrotic therapy for a wider range of fibrotic ILD, manifested in a decrease in the annual rate of FVC reduction. And in 2020, the use of the first anti-fibrotic drug was approved for the treatment of patients with advanced pulmonary fibrosis, NOT related to idiopathic pulmonary fibrosis (IPF).

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Peripheral Blood Biomarkers for Rheumatoid Arthritis–Associated Interstitial Lung Disease: A Systematic Review

Kalsbeek

Brooks

Shaver

et al. 2023

ACR Open Rheumatology

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Background Biomarkers have been proposed as tools to aid in the identification and prognostication of interstitial lung disease (ILD) in rheumatoid arthritis (RA). We performed a systematic review of studies evaluating peripheral blood biomarkers and their association with RA‐ILD and its prognosis. Methods Medline, Embase, the Cochrane Library, and Scopus were queried for relevant studies, with the final search update on July 12, 2021. We included studies evaluating peripheral blood biomarkers for the identification and/or prognostication of RA‐ILD, extracting the performance of individual biomarkers for identifying RA‐ILD, and predicting prognosis. Modified versions of the Quality Assessment of Diagnostic Accuracy Studies 2 and the Quality in Prognosis Studies tools were used for quality assessment. Results Seventy studies met eligibility criteria. Study and patient characteristics, analytical methods, strength and consistency of associations, and study quality were heterogeneous. A total of 92 biomarkers were positively associated and 12 were negatively associated with RA‐ILD among patients with RA in one or more report. Only a small number of biomarkers were evaluated in multiple cohorts using adjusted analyses. Biomarkers most strongly associated with RA‐ILD overlapped with those identified for idiopathic pulmonary fibrosis. Few prognostic biomarkers of RA‐ILD were identified. Conclusion Several peripheral blood biomarkers are associated with the presence of RA‐ILD, but few have been assessed in multivariable models, have been externally validated, have discriminated RA‐ILD from other lung disease, or have prognosticated the disease course. High‐quality studies investigating and validating peripheral biomarkers in RA‐ILD are needed before they can be employed in clinical care.

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Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease: Lights and Shadows

Cited by 77 publications

References 208 publications

Pathogenesis and treatment of idiopathic and rheumatoid arthritis-related interstitial pneumonia. The possible lesson from COVID-19 pneumonia

Pathogenesis and treatment of idiopathic and rheumatoid arthritis-related interstitial pneumonia. The possible lesson from COVID-19 pneumonia

Interstitial lung diseases with progressive pulmonary fibrosis: pathogenetic features and approaches to therapy

Peripheral Blood Biomarkers for Rheumatoid Arthritis–Associated Interstitial Lung Disease: A Systematic Review

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