Rheumatoid Arthritis-Associated Interstitial Lung Disease: Current Concepts

Abstract

Correlative clinico-epidemiological studies have identified key risk factors for disease progression. Complementing these findings, the identification of specific molecular and serological markers of RA-ILD has improved our understanding of disease pathogenesis and established the foundation for predictive biomarker profiling. Experience from case series and cohort studies suggests that newer biological agents such as rituximab may be viable treatment options. RA-ILD continues to have a major impact on "disease intrinsic" morbidity and mortality. Increased understanding of disease pathogenesis and the natural history of subclinical RA-ILD will promote the development of more refined therapeutic strategies.

Immune checkpoint inhibitor–induced inflammatory arthritis as a model of autoimmune arthritis

“…Interstitial lung disease (ILD), rheumatoid nodules, rheumatoid vasculitis, and scleritis are some of the conditions that can accompany joint disease. ILD varies in severity and is clinically apparent in 6‐30% of RA patients depending on how it is diagnosed . However, asymptomatic subclinical ILD has been reported in up to 60% of patients.…”

“…ILD varies in severity and is clinically apparent in 6-30% of RA patients depending on how it is diagnosed. 44 However, asymptomatic subclinical ILD has been reported in up to 60% of patients. Patients with RA also have an increased risk of lymphoma, lung cancer, and cardiovascular disease.…”

Lung inflammation in the pathogenesis of rheumatoid arthritis

“…Furthermore, patient‐related factors also influence lung disease in RA; these include exposure to tobacco, sex/gender duration, and severity of articular disease . Some studies suggest that up to 70% of subjects with RA may have some form of lung disease especially if ascertained by imaging studies such as computed tomography that are very sensitive for detection of abnormalities; importantly however, in a majority of those subjects, the disease may not have been clinically diagnosed and would therefore be considered “subclinical” and indeed the prevalence of symptomatic lung disease in RA is not well established …”

“…Many of the same risk factors associated with AD in RA are also associated with ILD. These include older age, male gender, smoking, and exposure to occupational dust . In a study by Gochuico and colleagues, 71% of RA‐ILD patients were former smokers compared to 23% of RA patients without ILD .…”

“…It will also be important in going forward to identify the best approaches to identify and treat lung disease in RA. Importantly, while there is a high prevalence of lung disease in RA, much of lung disease in RA may be termed “subclinical” which means it was not otherwise identified by clinicians caring for the individuals with RA . This is likely because rheumatologists lack a uniform approach to assessing lung disease in RA, often because care is focused on articular disease.…”