TACKLING RHEUMATOID ARTHRITIS-RELATED INTERSTITIAL LUNG DISEASE (RA-ILD) WITH CUTTING-EDGE MEDICATION STRATEGIES- A REVIEW ARTICLE
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Keywords
lungs, joints, fibrosis, pulmonary, rheumatoid, arthritis, therapy
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disorder that primarily targets the joints but also presents significant extra-articular complications, notably interstitial lung disease (ILD). RA-associated ILD (RA-ILD) is a severe complication contributing to increased morbidity and mortality among RA patients. This review systematically examines RA-ILD, including its pathogenesis, clinical manifestations, diagnostic techniques, and current treatment strategies. RA impacts 0.5–1% of the global population, causing chronic joint inflammation and pain, but it also has substantial effects beyond the joints. Among these, ILD is the most common and critical pulmonary manifestation, leading to progressive fibrosis in the lung tissue, which significantly increases morbidity and mortality rates.
RA-ILD predominantly presents in two forms: usual interstitial pneumonia and nonspecific interstitial pneumonia. Recent research has shed light on the epidemiology of RA-ILD and identified several risk factors, including smoking, male gender, specific human leukocyte antigen haplotypes, rheumatoid factor, and anti-cyclic citrullinated protein antibodies (ACPAs). The diagnostic approach combines clinical evaluation, chest examinations, pulmonary function tests, and high-resolution computed tomography (HRCT) of the chest to determine the subtype and extent of the disease.
Managing RA-ILD is challenging due to the lack of large randomized controlled trials providing clear guidance. The therapeutic complexity is compounded by the fact that many effective drugs for joint symptoms, such as methotrexate, leflunomide, and anti-tumour necrosis factor alpha agents, can potentially induce or worsen ILD. Promising treatment options include immunomodulators like mycophenolate and rituximab, as well as newly investigated antifibrotic agents. This review explores the current literature to offer management recommendations for RA-ILD and highlights critical gaps in our understanding of this complex condition.
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Ahmar Hasan
Senior Resident, Department of Pharmacology, Jawaharlal Nehru Medical College; Hospital,A.M.U., Aligarh
Syed Ziaur Rahman
Senior Resident, Department of Pharmacology, Jawaharlal Nehru Medical College; Hospital,A.M.U., Aligarh