SER-SEPAR recommendations for the management of rheumatoid arthritis-related interstitial lung disease. Part 1: Epidemiology, risk factors and prognosis

Portal, José Antonio Rodríguez; García, Noé Brito; Fontecha, Petra Díaz del Campo; Valenzuela, Claudia; Ortiz, Ana M.; Nieto, Maria Asuncion; Mena-Vázquez, Natalia; Cano-Jiménez, Esteban; Castellví, Iván; Aburto, Myriam; Bonilla, Gema; Hernández, María Vanesa Hernández; Hernández, Félix Manuel Francisco; Plaza, María Correyero; Castrejón, Isabel; Hernández, Miguel Ángel Abad; Narváez, Javier

doi:10.1016/j.reumae.2022.02.004

Cited by 5 publications

(11 citation statements)

References 78 publications

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“…Moreover, the presence of ACPA, especially at higher titers, is another factor that is widely known to be associated with RA-ILD [ 33 ]. In fact, to date, none of the biomarkers under study have been proven to have a higher predictive value for ILD than ACPA [ 2 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…As for the progression of lung disease, we defined 3 stages: [ 1 ] progression (worsening of forced vital capacity [FVC] > 10% or the diffusing capacity of the lungs for carbon monoxide [DLCO] > 15%); [ 2 ] non-progression (stability or improvement in FVC ≤ 10% or DLCO ≤ 15%); and [ 3 ] improvement (increase in FVC > 10% or DLCO > 15%) [ 11 ]. PFT included complete spirometry, which was expressed as a percent that was predicted and adjusted for age, sex, and height.…”

Section: Methodsmentioning

confidence: 99%

“…None of these proteins are yet available in clinical practice. Similarly, they have not been proven to have a greater predictive value than the anti–citrullinated peptide antibody (ACPA) [ 11 , 12 ]. Other studies have described that elevated uric acid levels, D-dimer, and tumor markers may be diagnostic markers in RA-ILD [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…While interest in ILD has grown in the last 10 years, and studies are being performed to gain a greater insight into the clinical characteristics and risk factors associated with RA-ILD, our knowledge remains very limited [ 2 , 11 ]. Given the absence of a clinically validated biomarker to improve the diagnosis of early RA-ILD and/or to predict the response to treatment, this disease is usually diagnosed late and is based on multiple complex diagnostic tests.…”

Section: Introductionmentioning

confidence: 99%

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Inflammatory Biomarkers in the Diagnosis and Prognosis of Rheumatoid Arthritis–Associated Interstitial Lung Disease

Mena-Vázquez

Godoy-Navarrete

Lisbona-Montañez

et al. 2023

IJMS

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Objectives: to identify inflammatory factors and soluble cytokines that act as biomarkers in the diagnosis and prognosis of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Methods: we performed a nested prospective observational case–control study of patients with RA-ILD matched by sex, age, and time since the diagnosis of RA. All participants underwent pulmonary function testing and high-resolution computed tomography. ILD was defined according to the criteria of the American Thoracic Society/European Respiratory Society; the progression of lung disease was defined as the worsening of FVC > 10% or DLCO > 15%. Inflammation-related variables included the inflammatory activity measured using the DAS28-ESR and a multiplex cytokine assay. Two Cox regression models were run to identify factors associated with ILD and the progression of ILD. Results: the study population comprised 70 patients: 35 patients with RA-ILD (cases) and 35 RA patients without ILD (controls). A greater percentage of cases had higher DAS28-ESR (p = 0.032) and HAQ values (p = 0.003). The variables associated with RA-ILD in the Cox regression analysis were disease activity (DAS28) (HR [95% CI], 2.47 [1.17–5.22]; p = 0.017) and high levels of ACPA (HR [95% CI], 2.90 [1.24–6.78]; p = 0.014), IL-18 in pg/mL (HR [95% CI], 1.06 [1.00–1.12]; p = 0.044), MCP-1/CCL2 in pg/mL (HR [95% CI], 1.03 [1.00–1.06]; p = 0.049), and SDF-1 in pg/mL (HR [95% CI], 1.00 [1.00–1.00]; p = 0.010). The only variable associated with the progression of ILD was IL-18 in pg/mL (HR [95% CI], 1.25 [1.07–1.46]; p = 0.004). Conclusion: inflammatory activity was higher in patients with RA-ILD than RA patients without ILD. Some cytokines were associated with both diagnosis and poorer prognosis in patients with RA-ILD.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Inflammatory Biomarkers in the Diagnosis and Prognosis of Rheumatoid Arthritis–Associated Interstitial Lung Disease

Mena-Vázquez

Godoy-Navarrete

Lisbona-Montañez

et al. 2023

IJMS

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“…It is disconcerting that ILD is not mentioned in the latest 2022 European Alliance of Associations for Rheumatology (EULAR) recommendations for the management of RA ( 186 ) while the 2021 American College of Rheumatology (ACR) guidelines only advise to pay attention on the role of methotrexate (MTX) in patients with a previous diagnosis of lung or airway disease without addressing ILD ( 187 ). At a local level, ILD was included in the Taiwan Society of Rheumatology recommendations for the management of comorbidities and extra-articular manifestations of RA ( 188 ), and in the Spanish Societies of Rheumatology (SER), Pneumology and Thoracic Surgery (SEPAR) guidelines for the management of RA-ILD ( 189 , 190 ). In the aforementioned documents, there is general accordance against the use of MTX and leflunomide (LEF), in favor of rituximab or abatacept ( 188 , 189 ), despite a recent meta-analysis found that MTX is not associated with the risk of ILD in RA ( 191 ).…”

Section: The Current Clinical Practice In the Management Of Ra-ildmentioning

confidence: 99%

Unmet needs and perspectives in rheumatoid arthritis-associated interstitial lung disease: A critical review

et al. 2023

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Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterized by synovitis as the most common clinical manifestation, and interstitial lung disease (RA-ILD) represents one of the most common and potentially severe extra-articular features. Our current understanding of the mechanisms and predictors of RA-ILD is limited despite the demonstration that an early identification of progressive fibrosing forms is crucial to provide timely treatment with antifibrotic therapies. While high resolution computed tomography is the gold standard technique for the diagnosis and follow-up of RA-ILD, it has been hypothesized that serum biomarkers (including novel and rare autoantibodies), new imaging techniques such as ultrasound of the lung, or the application of innovative radiologic algorithms may help towards predicting and detecting early forms of diseases. Further, while new treatments are becoming available for idiopathic and connective tissue disease-associated forms of lung fibrosis, the treatment of RA-ILD remains anecdotal and largely unexplored. We are convinced that a better understanding of the mechanisms connecting RA with ILD in a subgroup of patients as well as the creation of adequate diagnostic pathways will be mandatory steps for a more effective management of this clinically challenging entity.

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Screening for rheumatoid arthritis-associated interstitial lung disease—a Delphi-based consensus statement

Hackner,

Hütter,

Flick

et al. 2024

Z Rheumatol

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Objective Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a major driver of premature mortality in patients with rheumatoid arthritis (RA). Detection of RA-ILD is crucial but requires awareness among the treating physicians. To date, however, there is no international recommendation concerning screening for ILD in RA patients. Methods After a systematic literature review, the modified Delphi technique in combination with the nominal group technique was used to provide a Delphi consensus statement elaborated by an expert panel of pneumonologists, rheumatologists, and a radiologist. Based on the available evidence, several clusters of questions were defined and discussed until consent was reached. Results A screening algorithm for ILD in patients with RA based on clinical signs, respiratory symptoms, and risk factors has been developed. Further, the recommendations address diagnostic tools for RA-ILD and the follow-up of RA patients qualifying for ILD screening.

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SER-SEPAR recommendations for the management of rheumatoid arthritis-related interstitial lung disease. Part 1: Epidemiology, risk factors and prognosis

Cited by 5 publications

References 78 publications

Inflammatory Biomarkers in the Diagnosis and Prognosis of Rheumatoid Arthritis–Associated Interstitial Lung Disease

Inflammatory Biomarkers in the Diagnosis and Prognosis of Rheumatoid Arthritis–Associated Interstitial Lung Disease

Unmet needs and perspectives in rheumatoid arthritis-associated interstitial lung disease: A critical review

Screening for rheumatoid arthritis-associated interstitial lung disease—a Delphi-based consensus statement

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