[Pulmonary involvement in rheumatoid arthritis]

Area of Science:

• Rheumatology
• Pulmonology
• Immunology

Background:

• Pulmonary involvement, particularly interstitial lung diseases (RA-ILD), is a significant clinical concern in rheumatoid arthritis (RA) patients.
• Early detection and regular monitoring of lung symptoms and function are crucial throughout the disease course.

Purpose of the Study:

• To outline diagnostic and therapeutic strategies for managing interstitial lung disease in rheumatoid arthritis patients.
• To clarify the current understanding of pharmacological treatments for RA-ILD.

Main Methods:

• Clinical examination and symptom assessment for pulmonary involvement.
• Mandatory chest X-ray before initiating basic pharmacotherapy.
• Extended diagnostics including lung function tests (e.g., body plethysmography, diffusion capacity) and high-resolution CT for suspicious findings.

Main Results:

• Methotrexate (MTX) may show improved outcomes in mild to moderate RA-ILD, contrary to previous beliefs.
• Tumor necrosis factor (TNF) inhibitors are associated with potential severe pulmonary deterioration and should be avoided in clinically relevant RA-ILD.
• Rituximab and abatacept are currently favored among biological disease-modifying antirheumatic drugs (DMARDs) for RA-ILD.

Conclusions:

• Optimal pharmacological treatment for RA-ILD is still under investigation, with evolving perspectives on methotrexate's role.
• Close collaboration between pulmonologists and rheumatologists is essential for optimal patient management and outcomes in RA-ILD.