Unmet needs and perspectives in rheumatoid arthritis-associated interstitial lung disease: A critical review

Abstract

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterized by synovitis as the most common clinical manifestation, and interstitial lung disease (RA-ILD) represents one of the most common and potentially severe extra-articular features. Our current understanding of the mechanisms and predictors of RA-ILD is limited despite the demonstration that an early identification of progressive fibrosing forms is crucial to provide timely treatment with antifibrotic therapies. While high resolution computed tomography is the gold standard technique for the diagnosis and follow-up of RA-ILD, it has been hypothesized that serum biomarkers (including novel and rare autoantibodies), new imaging techniques such as ultrasound of the lung, or the application of innovative radiologic algorithms may help towards predicting and detecting early forms of diseases. Further, while new treatments are becoming available for idiopathic and connective tissue disease-associated forms of lung fibrosis, the treatment of RA-ILD remains anecdotal and largely unexplored. We are convinced that a better understanding of the mechanisms connecting RA with ILD in a subgroup of patients as well as the creation of adequate diagnostic pathways will be mandatory steps for a more effective management of this clinically challenging entity.

Interstitial Lung Disease Is Associated with Sleep Disorders in Rheumatoid Arthritis Patients

“…We also found the UIP radiologic pattern to be associated with lower sleep satisfaction in the cases. Other authors report that the most fibrotic forms of ILD, especially UIP-type ILD, have been associated with poorer quality of life, greater disease progression, and mortality in affected patients [39]. Moreover, this type of interstitial involvement tends to respond worse to treatment, and the course of the disease is similar to that of idiopathic pulmonary fibrosis [40].…”

Impact of DMARD treatment and systemic inflammation on all-cause mortality in patients with rheumatoid arthritis and interstitial lung disease: a cohort study from the German RABBIT register

“…19 22 31 However, recent review addresses the limited evidence on which recommendations are based. 31 Furthermore, the American College of Rheumatology (ACR) recently released guideline recommends RTX and tocilizumab (TOC) as treatment for RA-ILD. 32 It is known that a high comorbidity burden increases the risk of not receiving any DMARDs, 33 but there is a lack of information on treatment patterns in patients with RA-ILD, including the impact of non-treatment with DMARDs on mortality.…”

“… 19 22 31 However, recent review addresses the limited evidence on which recommendations are based. 31 Furthermore, the American College of Rheumatology (ACR) recently released guideline recommends RTX and tocilizumab (TOC) as treatment for RA-ILD. 32…”

Association of a Single Nucleotide Variant in TERT with Airway Disease in Japanese Rheumatoid Arthritis Patients

“…Rheumatoid arthritis (RA) is a chronic inflammatory disease that destroys synovial joints [1]. RA is often associated with extra-articular manifestations that include interstitial lung disease, airway disease (AD), vasculitis, pleuritis, pericarditis, and Felty's syndrome [2]. Interstitial lung disease is characterized by interstitial inflammation of the lung and is found in about 10% of RA patients [3].…”