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

ABSTRACT

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.

KEYWORDS:

• COVID-19
• rheumatoid arthritis
• interstitial lung disease
• toll-like receptor
• idiopathic pulmonary fibrosis
• acute exacerbation

Article highlights

• COVID-19 pneumonia resembles many pathogenetic and radiologic features of idiopathic and rheumatoid arthritis related usual interstitial pneumonia

• Toll-like receptor 4 plays a crucial role in the pathogenesis of both COVID-19 and usual interstitial pneumonia

• The modulation of toll-like receptor 4 could explain the safety of some disease modifying antirheumatic drugs, such as abatacept, in patients with rheumatoid arthritis related interstitial lung disease

• Acute exacerbation of interstitial lung disease shares many features with acute respiratory distress syndrome in COVID-19 pneumonia

• The use of tocilizumab, sarilumab and baricitinib, used in severe COVID-19 pneumonia, could also be suggested for the treatment of acute exacerbation of interstitial lung disease

Acknowledgments

a special thanks to Gabriele D’Andrea from the Radiology Unit of San Gerardo Hospital of Monza, for the support in iconography

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.