Management issues in rheumatoid arthritis-associated interstitial lung disease

Purpose of review Summarize recent evidence on the identification and management of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Recent findings Clinical and subclinical interstitial lung disease (ILD) are frequent extra-articular manifestations of rheumatoid arthritis (RA). Better means of identifying and treating RA-ILD are needed to improve the prognosis, with a median survival of only 3–7 years after diagnosis. Several serum biomarkers are currently being evaluated for their ability to detect RA-ILD. Thorough evaluation and multidisciplinary discussion remains the gold standard for establishing the diagnosis of RA-ILD. Management is challenging with most RA disease-modifying antirheumatic drugs (DMARDs) linked to pneumonitis. Methotrexate is typically avoided in clinically significant ILD, although alternative therapies including leflunomide and biologic DMARDs also carry risks in RA-ILD. Antifibrotics appear to slow the progression of ILD, and a large phase II trial exclusively in RA-ILD is underway. In addition, smoking cessation, pulmonary rehabilitation, oxygen therapy, managing comorbidities, and lung transplantation evaluation are vital to improving patient outcomes in RA-ILD. Summary With little high-quality evidence to guide the management of RA-ILD, multidisciplinary teams with expertise in RA-ILD are highly valuable for diagnosing and treating RA-ILD. Clinical and translational research in RA-ILD is needed to fill the many ev...
Source: Current Opinion in Rheumatology - Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Joshua F. Baker Source Type: research

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In conclusion, we retrieved more than one line of evidence for mucosal sites and different microbial taxa to be potentially involved in the development of RA. This review gives an overview of infectious agents and mucosal pathologies, and discusses the current evidence for causality between different exogenous or mucosal factors and systemic inflammation in RA.
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Abstract BACKGROUND: Interstitial lung abnormalities (ILA) and interstitial lung disease (ILD) are seen in up to 60% of individuals with rheumatoid arthritis (RA), some of which will progress to have a significant impact on morbidity and mortality. Better characterization of progressive interstitial changes and identification of risk factors associated with progression may enable earlier intervention and improved outcomes. RESEARCH QUESTION: what are baseline characteristics associated with RA-ILD progression? STUDY DESIGN: and Methods: Retrospective study where all clinically-indicated computed tomograp...
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest Source Type: research
Clinically amyotrophic dermatomyositis (CADM), a subset of dermatomyositis (DM), is a rare autoimmune disease characterized by typical DM cutaneous findings (e.g., heliotrope rash, Gottron papules, Gottron sign) without evidence of myositis.1 The incidence of DM and CADM is approximately 9.63 per 1 million people and 2.08 per 1 million people, respectively.2 The association with development... [Read More]
Source: The Rheumatologist - Category: Rheumatology Authors: Tags: Conditions Rheumatoid Arthritis Clinically Amyotrophic Dermatomyositis (CADM) combination therapy interstitial lung disease (ILD) Source Type: research
CONCLUSIONS: Treatment with b/tsDMARDs is effective and well tolerated in elderly patients with RA; nonetheless, ILD is a key comorbidity that should be monitored carefully. PMID: 32324126 [PubMed - as supplied by publisher]
Source: Clinical and Experimental Rheumatology - Category: Rheumatology Tags: Clin Exp Rheumatol Source Type: research
Condition:   Interstitial Lung Disease in Patients With Rheumatoid Arthritis Intervention:   Diagnostic Test: serum cxcl10 by ELISA Sponsor:   Assiut University Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
The presence of a systemic autoimmune rheumatic disease (ARD) is a well-known risk factor for interstitial lung disease (ILD). For example, 33% of adults with rheumatoid arthritis (RA) have subclinical ILD [1]. Higher serum levels of IgM rheumatoid factor (RF), IgA RF, and anti-cyclic citrullinated peptide antibody 2 are associated with subclinical ILD in community-dwelling adults [2]. It is unknown whether this relationship between autoimmunity and subclinical ILD is limited to RA-related autoantibodies, or extends more broadly to other epitopes. High attenuation areas (HAA) and interstitial lung abnormalities (ILA) are v...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Original Articles: Research letters Source Type: research
Authors: Sesé L, Jeny F, Uzunhan Y, Khamis W, Freynet O, Valeyre D, Bernaudin JF, Annesi-Maesano I, Nunes H Abstract Few studies have examined the effects of air pollution in diffuse interstitial lung disease and they have focused on small numbers of patients. Most data are available in idiopathic pulmonary fibrosis and studies suggest that the level of exposure to pollutants may influence the development of acute exacerbations (ozone and NO2), their incidence (NO2), decline in respiratory function (PM10) and death (PM10 and PM2.5). Several studies show an increase in the incidence of rheumatoid arthritis in...
Source: Revue des Maladies Respiratoires - Category: Respiratory Medicine Tags: Rev Mal Respir Source Type: research
Authors: Zhao F, Zhang WD, Jiang YL, Liu W, Cao J PMID: 32253899 [PubMed - in process]
Source: Journal of Biological Regulators and Homeostatic Agents - Category: Biomedical Science Tags: J Biol Regul Homeost Agents Source Type: research
Publication date: Available online 4 April 2020Source: Respiratory Medicine Case ReportsAuthor(s): Giulia Cassone, Marco Sebastiani, Caterina Vacchi, Stefania Cerri, Carlo Salvarani, Andreina Manfredi
Source: Respiratory Medicine Case Reports - Category: Respiratory Medicine Source Type: research
This paper is to examine the relationship between serum soluble programmed death ligand 1(sPD-L1) levels and the development of interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA).
Source: Respiratory Medicine - Category: Respiratory Medicine Authors: Source Type: research
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