Practical Management of Respiratory Comorbidities in Patients with Rheumatoid Arthritis

Abstract

Lung disease is one of the most common causes of extra-articular morbidity and mortality in patients with rheumatoid arthritis (RA). Development of pulmonary manifestations may be due to the systemic disease itself; to serious respiratory adverse events such as pneumonitis and infections secondary to therapy; or to lifestyle habits such as smoking. Rheumatologists often need to make important treatment decisions and plan future care in RA patients with respiratory comorbidities, despite the absence of clear evidence or consensus. In this review we evaluate the clinical assessment and management of RA-associated interstitial lung disease, bronchiectasis, serious (including opportunistic) infection, and smoking-related diseases. We summarize the international recommendations for the management of such conditions where available, refer to published best practice on the basis of scientific literature, and propose practical management suggestions to aid informed decision-making.

Keywords: Disease-modifying antirheumatic drugs; Respiratory tract diseases; Rheumatoid arthritis; Safety; Smoking.

Fig. 1

Suggested algorithm for assessment, monitoring, and management of patients with RA-ILD. AFB acid-fast bacilli, DLCO diffusion capacity of the lung for carbon monoxide, FVC forced vital capacity, HRCT high-resolution CT, NSIP nonspecific interstitial pneumonia, PFTs pulmonary function tests, RA-ILD rheumatoid arthritis-associated interstitial lung disease, UIP usual interstitial pneumonia. Reproduced, with permission by Nature. Initially published in [47]