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

Rheumatoid arthritis (RA) is a chronic and systemic inflammatory disease affecting 0.5-1% of the population worldwide. Interstitial lung disease (ILD) is a serious pulmonary complication of RA and it is responsible for 10-20% of mortality, with a mean survival of 5-8 years. However, nowadays there a...

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Published inJournal of clinical medicine Vol. 9; no. 4; p. 1082
Main Authors Cassone, Giulia, Manfredi, Andreina, Vacchi, Caterina, Luppi, Fabrizio, Coppi, Francesca, Salvarani, Carlo, Sebastiani, Marco
Format Journal Article
LanguageEnglish
Published Switzerland MDPI AG 10.04.2020
MDPI
Subjects
antifibrotic agents
Biopsy
Clinical medicine
Decision making
DMARDs
Drugs
Immunosuppressive agents
Infections
interstitial lung disease
Lung diseases
Medical prognosis
Mortality
Patients
Pneumonia
Review
Rheumatoid arthritis
Rheumatology
Steroids
therapy
antifibrotic agents
DMARDs
interstitial lung disease
rheumatoid arthritis
therapy
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Summary:Rheumatoid arthritis (RA) is a chronic and systemic inflammatory disease affecting 0.5-1% of the population worldwide. Interstitial lung disease (ILD) is a serious pulmonary complication of RA and it is responsible for 10-20% of mortality, with a mean survival of 5-8 years. However, nowadays there are no therapeutic recommendations for the treatment of RA-ILD. Therapeutic options for RA-ILD are complicated by the possible pulmonary toxicity of many disease modifying anti-rheumatic drugs (DMARDs) and by their unclear efficacy on pulmonary disease. Therefore, joint and lung involvement should be evaluated independently of each other for treatment purposes. On the other hand, some similarities between RA-ILD and idiopathic pulmonary fibrosis and the results of the recent INBIULD trial suggest a possible future role for antifibrotic agents. From this perspective, we review the current literature describing the pulmonary effects of drugs (immunosuppressants, conventional, biological and target synthetic DMARDs and antifibrotic agents) in patients with RA and ILD. In addition, we suggest a framework for the management of RA-ILD patients and outline a research agenda to fill the gaps in knowledge about this challenging patient cohort.
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ISSN:2077-0383
2077-0383
DOI:10.3390/jcm9041082