Diffuse lung involvement in rheumatoid arthritis: a respiratory physician's perspective.

Area of Science:

• Pulmonology
• Rheumatology
• Internal Medicine

Background:

• Rheumatoid arthritis (RA) commonly affects extra-articular organs, with lung involvement reported in 60-80% of patients.
• Respiratory complications are the second leading cause of mortality in RA patients.
• Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is the most frequent pulmonary manifestation and significantly impacts RA prognosis.

Approach:

• This review provides an update on the diagnosis and treatment of RA-associated respiratory diseases from a chest physician's perspective.
• It covers rheumatoid arthritis-associated interstitial lung disease (RA-ILD), methotrexate-associated lung disease, and Pneumocystis jiroveci pneumonia in RA.
• Recent advancements in understanding opportunistic pulmonary infections and RA therapy toxicity are also discussed.

Key Points:

• Interstitial lung disease (ILD) is the most common lung manifestation in RA, significantly affecting patient outcomes.
• Methotrexate, a common RA treatment, can lead to lung toxicity (methotrexate-associated lung disease).
• Pneumocystis jiroveci pneumonia is a potential opportunistic infection in RA patients, requiring specific diagnostic and treatment considerations.

Conclusions:

• Comprehensive understanding and management of RA-associated lung diseases are crucial for improving patient prognosis.
• Early diagnosis and appropriate treatment of RA-ILD, methotrexate lung disease, and opportunistic infections are essential.
• Multidisciplinary collaboration between rheumatologists and pulmonologists is vital for optimal patient care.