Better Safe than Sorry: Rheumatoid Arthritis, Interstitial Lung Disease, and Medication—A Narrative Review

Andronache, Iulia-Tania; Şuţa, Victoria-Cristina; Şuţa, Maria; Ciocodei, Sabina-Livia; Vladareanu, Liliana; Nicoara, Alina Doina; Arghir, Oana Cristina

doi:10.3390/biomedicines11061755

Cited by 3 publications

(1 citation statement)

References 66 publications

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“…Another point to be addressed is the possible effect of steroids, methotrexate, or biologic DMARDs on the progression of RA-ILD. The available data are contradictory about the possibility that these drugs might reduce or increase the progression of lung involvement in RA patients [29,30].…”

Section: Discussionmentioning

confidence: 99%

Fibrosing Progressive Interstitial Lung Disease in Rheumatoid Arthritis: A Multicentre Italian Study

Sebastiani,

Venerito,

Laurino

et al. 2023

JCM

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Background: The INBUILD study demonstrated the efficacy of nintedanib in the treatment of progressive fibrosing interstitial lung disease different to idiopathic pulmonary fibrosis, including rheumatoid arthritis (RA)-related ILD. Nevertheless, the prevalence of RA-ILD patients that may potentially benefit from nintedanib remains unknown. Objectives and methods: The aim of the present multicentre study was to investigate the prevalence and possible associated factors of fibrosing progressive patterns in a cross-sectional cohort of RA-ILD patients. Results: One hundred and thirty-four RA-ILD patients with a diagnosis of RA-ILD, who were confirmed at high-resolution computed tomography and with a follow-up of at least 24 months, were enrolled. The patients were defined as having a progressive fibrosing ILD in case of a relative decline in forced vital capacity > 10% predicted and/or an increased extent of fibrotic changes on chest imaging in a 24-month period. Respiratory symptoms were excluded to reduce possible bias due to the retrospective interpretation of cough and dyspnea. According to radiologic features, ILD was classified as usual interstitial pneumonia (UIP) in 50.7% of patients, nonspecific interstitial pneumonia in 19.4%, and other patterns in 29.8%. Globally, a fibrosing progressive pattern was recorded in 36.6% of patients (48.5% of patients with a fibrosing pattern) with a significant association to the UIP pattern. Conclusion: We observed that more than a third of RA-ILD patients showed a fibrosing progressive pattern and might benefit from antifibrotic treatment. This study shows some limitations, such as the retrospective design. The exclusion of respiratory symptoms’ evaluation might underestimate the prevalence of progressive lung disease but increases the value of results.

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Section: Discussionmentioning

confidence: 99%

Fibrosing Progressive Interstitial Lung Disease in Rheumatoid Arthritis: A Multicentre Italian Study

Sebastiani,

Venerito,

Laurino

et al. 2023

JCM

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Pulmonary involvement in newly diagnosed and untreated rheumatoid arthritis and psoriatic arthritis: a prospective longitudinal study

Winter,

Petzinna,

Skowasch

et al. 2024

Rheumatol Int

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Objectives To longitudinally assesses pulmonary involvement in newly diagnosed rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients over a 12-months follow-up. To identify biomarkers and establish a diagnostic algorithm for monitoring pulmonary changes. Methods Newly diagnosed RA and PsA patients were examined with clinical and laboratory assessments, pulmonary function tests (PFT), and chest radiography (CXR) at three-months intervals for one year. Results The study enrolled 50 patients (26 RA, 24 PsA) and 26 controls. At baseline, 37.0% of arthritis patients (50.0% RA, 22.7% PsA) exhibited radiographic pulmonary involvement, with 64.7% being asymptomatic. No association was observed between CXR and PFTs. Reduced pathological breathing width was noted in 64.0% of patients (RA 69.2%, PsA 58.3%) and 23.1% of controls (p < .001). Thoracic excursion and lung auscultation showed no differences. During follow-up, PFT and physical examination findings remained stable. Mean CRP levels significantly decreased in RA patients from 23.5 mg/l (± 33.6; 95% CI: 9.9–37.1) to 2.7 mg/L (± 3.4; 95% CI: 1.0-4.3), and in PsA patients from 13.3 mg/L (± 18.0; 95% CI: 5.7–20.9) to 8.1 mg/L (± 16.2; 95% CI: 0.1–16.2) (p < .001). Additionally, significant reductions in disease activity scores and improvements in six-minute walking distance were observed (p < .001). No associations were identified between PFT outcomes, disease activity, or rheumatological medications throughout the disease course. Conclusion Our study underscores the prevalence of significant, predominantly asymptomatic pulmonary involvement in newly diagnosed RA and PsA patients. The lack of correlation between pulmonary function, disease activity, and medication during disease progression suggests that reducing arthritic disease activity does not necessarily mitigate the risk or severity of pulmonary involvement. Finally, our finding underscore the need for more sensitive biomarkers and optimized monitoring strategies.

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Molecular Mechanisms, Diagnoses, and Treatments of Respiratory Diseases

Shen

2024

Biomedicines

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Better Safe than Sorry: Rheumatoid Arthritis, Interstitial Lung Disease, and Medication—A Narrative Review

Cited by 3 publications

References 66 publications

Fibrosing Progressive Interstitial Lung Disease in Rheumatoid Arthritis: A Multicentre Italian Study

Fibrosing Progressive Interstitial Lung Disease in Rheumatoid Arthritis: A Multicentre Italian Study

Pulmonary involvement in newly diagnosed and untreated rheumatoid arthritis and psoriatic arthritis: a prospective longitudinal study

Molecular Mechanisms, Diagnoses, and Treatments of Respiratory Diseases

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