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Updated: Mar 30, 2026

Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease

Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease

Published on: June 16, 2020

Rheumatoid arthritis-associated interstitial lung disease: A review.

Melanie David¹, Philippe Dieude², Pierre-Antoine Juge²

¹Department of Pulmonology, Foch Hospital, Suresnes, France.

Respiratory Medicine and Research

|March 28, 2026

Summary

Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a serious complication of rheumatoid arthritis (RA). Current evidence suggests methotrexate (MTX) may not increase RA-ILD risk and highlights the need for multidisciplinary care.

Keywords:

Antifibrotic agents Immunosuppressive therapy Interstitial lung diseases Methotrexate Rheumatoid arthritis Usual interstitial pneumonia

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Area of Science:

Rheumatology
Pulmonology
Immunology

Background:

Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a frequent and severe manifestation of rheumatoid arthritis (RA).
Limited evidence-based guidelines exist for RA-ILD screening and management.
RA-ILD significantly contributes to morbidity and mortality in RA patients.

Purpose of the Study:

To provide a comprehensive review of RA-ILD, covering epidemiology, risk factors, pathophysiology, diagnosis, and treatment.
To critically evaluate the role of methotrexate (MTX) in RA-ILD.
To summarize current therapeutic strategies and diagnostic challenges.

Main Methods:

Systematic synthesis of data from observational studies, randomized controlled trials (RCTs), and international guidelines.
Analysis of clinical aspects including natural history, imaging features, and management.
Focus on therapeutic options and diagnostic approaches for RA-ILD.

Main Results:

RA-ILD exhibits diverse clinical and radiological patterns, with usual interstitial pneumonia (UIP) being the most common on HRCT.
Methotrexate (MTX) does not appear to elevate RA-ILD risk and may be associated with lower incidence.
Promising, yet limited, evidence exists for immunosuppressants (mycophenolate mofetil, rituximab, abatacept) and antifibrotics (nintedanib, pirfenidone).
A multidisciplinary approach is crucial for RA-ILD diagnosis and treatment.

Conclusions:

RA-ILD necessitates individualized, multidisciplinary care, with optimal rheumatoid arthritis (RA) control as a primary management goal.
Recent data question the historical contraindication of methotrexate (MTX) in RA-ILD.
Further prospective studies and collaboration between rheumatologists and pulmonologists are vital for improving patient outcomes.