Interstitial lung disease in rheumatoid arthritis:Current concepts in pathogenesis,diagnosis and therapeutics
Interstitial lung disease in rheumatoid arthritis:Current concepts in pathogenesis,diagnosis and therapeutics作者机构：Hospital General Regional 180 Instituto Mexicano del Seguro Social (IMSS) Centro Universitario de Ciencias de la Salud (CUCS) Universidad de Guadalajara Hospital de Especialidades Centro Medico Nacional de Occidente Instituto Mexicano del Seguro Social (IMSS) Hospital General Regional 110 Departamento de Medicina Interna-Reumatologia Instituto Mexicano del Seguro Social (IMSS)
出 版 物：《World Journal of Rheumatology》 (世界风湿病学杂志)
年 卷 期：2015年第5卷第1期
页 面：1-22页
学科分类：10[医学]
主 题：Rheumatoid arthritis Interstitial lung disease Pathogenesis Diagnosis Therapeutic
摘 要：Rheumatoid arthritis(RA) is the most common chronic autoimmune inflammatory joint disease. RA-associated interstitial lung disease(RA-ILD) is a major extraarticular complication and causes symptoms that lead to a deterioration in the quality of life, high utilization of health resources, and an increased risk of earlier mortality. Early in the course of RA-ILD, symptoms are highly variable, making the diagnosis difficult. Therefore, a rational diagnostic strategy that combines an adequate clinical assessment with the appropriate use of clinical tests, including pulmonary function tests and high-resolution computed tomography, should be used. In special cases, lung biopsy or bronchioalveolar lavage should be performed to achieve an early diagnosis. Several distinct histopathological subtypes of RA-ILD are currently recognized. These subtypes also have different clinical presentations, which vary in therapeutic response and prognosis. This article reviews current evidence about the epidemiology of RA-ILD and discusses the varying prevalence rates observed in different studies. Additionally, aspects of RA-ILD pathogenesis, including the role of cytokines and other molecules such as autoantibodies, as well as the evidence linking several drugs used to treat RA with lung damage will be discussed. Some aspects of the clinical characteristics of RA-ILD are noted, and diagnostic strategies are reviewed. Finally, this article analyzes current treatments for RA-ILD, including immunosuppressive therapies and biologic agents, as well as other therapeutic modalities. The prognosis of this severe complication of RA is discussed. Additionally, this paper examines updated evidence from studies identifying an association between drugs used for the treatment of RA and the development of ILD.
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