[Therapy of pulmonary involvement of rheumatic diseases]

Pulmonary manifestations of rheumatologic diseases occur as an effect of immunological damage to the parenchyma and to the vasculature of the lung. Hence an intensive immunosuppressive management including the use of corticosteroids and cyclophosphamide as well as extracorporeal apheresis procedures has been suggested and found to be efficacious in small series of patients. Pulmonary hypertension secondary to inflammatory rheumatological disease is a well known complication of scleroderma and lupus. The new advent in the treatment of such conditions like bosentan or epoprostenol and their second generation followers opens new prospects towards the hitherto very dark prognosis for these patients. The most frequent pulmonary problem in rheumatological patients will be the increasingly frequent occurrence of microbial pneumonias due to aggressive therapeutic immunosuppression.