Rheumatoid arthritis related interstitial lung disease

ABSTRACT

Introduction

Interstitial lung disease (ILD) represents a frequent extra-articular manifestation of rheumatoid arthritis (RA) deeply impacting both quality of life and overall prognosis. Areas covered: A literature search was performed including PubMed, Embase, Scopus, and Web of Science. Many retrospective studies investigated the possible risk factors for RA-related ILD (RA-ILD), aiming to identify patients at risk. Among them, males, smokers, positivity of anti-citrullinated peptide antibodies have been associated with RA-ILD, such as some genetic haplotypes. Usual interstitial pneumonia is the histologic and radiologic pattern most frequently observed, followed by nonspecific interstitial pneumonia. Since lung involvement can represent the RA onset, an early differential diagnosis with idiopathic interstitial pneumonia can be difficult or sometimes impossible. High-resolution computed tomography represents the gold standard for ILD diagnosis, while multidisciplinary discussion should be required to assess disease staging, severity and progression.  Expert opinion: Management of RA-ILD patients is challenging due to the lack of evidence-based data regarding both assessment and treatment. Moreover, the high variability of clinical presentation and evolution makes it difficult to establish the correct therapeutic strategy. Currently, multidisciplinary approach, including at least rheumatologists, pulmonologists, and radiologists, is desirable to define therapy and follow-up strategies.

KEYWORDS:

• Antifibrotic drugs
• DMARDS
• high resolution computed tomography
• immunosuppressive drugs
• interstitial lung disease
• lung fibrosis
• multidisciplinary discussion
• rheumatoid arthritis
• velcro crackles

Article highlights

• Interstitial lung disease is a frequent extra-articular manifestation in course of rheumatoid arthritis

• Patients with rheumatoid arthritis related interstitial lung disease have increased morbidity and mortality

• Diagnosis of interstitial lung disease in patients with rheumatoid arthritis is often delayed due to the absence of screening programs

• Correct management of interstitial lung disease is not well defined, but a multidisciplinary discussion to define disease features and progression could represent the best approach

• For the lack of dedicated randomized clinical trials, treatment should be personalized according to specific articular and lung involvements

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.

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.