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Review
. 2020 Apr 10;9(4):1082.
doi: 10.3390/jcm9041082.

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

Giulia Cassone  1   2 , Andreina Manfredi  3 , Caterina Vacchi  1 , Fabrizio Luppi  4 , Francesca Coppi  5 , Carlo Salvarani  3 , Marco Sebastiani  3
Affiliations
Review

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

Giulia Cassone et al. J Clin Med. .

Abstract

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.

Keywords: DMARDs; antifibrotic agents; interstitial lung disease; rheumatoid arthritis; therapy.

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Conflict of interest statement

The authors declare they have no conflicts of interest.

Figures

Figure 1
Figure 1
Pulmonary effects of TNFi in RA-ILD patients: a review of the literature.
Figure 2
Figure 2
Pulmonary effects of abatacept in RA-ILD patients: a review of the literature.
Figure 3
Figure 3
Pulmonary effects of tocilizumab in RA-ILD patients: a review of the literature.
Figure 4
Figure 4
Pulmonary effects of rituximab in RA-ILD patients: a review of the literature.
Figure 5
Figure 5
Proposed framework for the management and treatment of RA-ILD patients. Therapeutic choice in patients with RA-ILD should derive by a multidisciplinary approach including a rheumatologist, pulmonologist, and radiologist. Use of DMARDs (mainly ABA, JAK inhibitors, IL6 inhibitors or RTX) should be evaluated according to the joint disease activity, while the progression of lung involvement and, possibly ILD pattern, can influence the decision to use immunosuppressants or, in selected patients, an antifibrotic drug.
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References

    1. Smolen J.S., Aletaha D., McInnes I.B. Rheumatoid arthritis. Lancet. 2016;388:2023–2038. doi: 10.1016/S0140-6736(16)30173-8. - DOI - PubMed
    1. Prete M., Racanelli V., Digiglio L., Vacca A., Dammacco F., Perosa F. Extra-articular manifestations of rheumatoid arthritis: An update. Autoimmun. Rev. 2011;11:123–131. doi: 10.1016/j.autrev.2011.09.001. - DOI - PubMed
    1. Yunt Z.X., Solomon J.J. Lung Disease in Rheumatoid Arthritis. Rheum. Dis. Clin. N. Am. 2015;41:225–236. doi: 10.1016/j.rdc.2014.12.004. - DOI - PMC - PubMed
    1. Esposito A.J., Chu S.G., Madan R., Doyle T.J., Dellaripa P.F. Thoracic Manifestations of Rheumatoid Arthritis. Clin. Chest Med. 2019;40:545–560. doi: 10.1016/j.ccm.2019.05.003. - DOI - PMC - PubMed
    1. Bongartz T., Nannini C., Medina-Velasquez Y.F., Achenbach S.J., Crowson C.S., Ryu J., Vassallo R., Gabriel S.E., Matteson E.L. Incidence and mortality of interstitial lung disease in rheumatoid arthritis: A population-based study. Arthritis Rheum. 2010;62:1583–1591. doi: 10.1002/art.27405. - DOI - PMC - PubMed

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