Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD): An Official 2025 ALAT Clinical Practice Guideline

Area of Science:

• Rheumatology
• Pulmonology
• Internal Medicine

Background:

• Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a severe complication and leading cause of mortality in rheumatoid arthritis (RA) patients.
• Usual interstitial pneumonia (UIP) is the most common form of ILD in RA, sharing features with idiopathic pulmonary fibrosis (IPF).

Purpose of the Study:

• To highlight the importance of early recognition of ILD in RA patients.
• To provide evidence-based guidelines for the management of RA-ILD.
• To emphasize the role of achieving articular activity remission in the treat-to-target strategy for mitigating ILD risk and progression.

Main Methods:

• Review of current literature and clinical guidelines regarding RA-ILD.
• Analysis of treatment strategies including disease-modifying antirheumatic drugs (DMARDs) and antifibrotics.
• Focus on screening protocols for early detection of ILD in RA.

Main Results:

• Early detection of ILD through screening can significantly alter treatment and prognosis for RA patients.
• Achieving remission of articular activity in RA is a key factor in preventing ILD development and progression.
• DMARDs and antifibrotic therapies are essential for managing RA-ILD and progressive pulmonary fibrosis.

Conclusions:

• Implementing early screening for ILD in RA patients is vital.
• Treating RA to achieve articular remission is a critical strategy to reduce ILD risk.
• A comprehensive management approach combining DMARDs and antifibrotics is necessary for patients with RA-ILD.