TY - JOUR
T1 - Recent advances in the pathogenesis, prediction, and management of rheumatoid arthritis-associated interstitial lung disease
AU - Johnson, Cheilonda
PY - 2017
Y1 - 2017
N2 - Purpose of review: To provide an overview of recently published articles covering interstitial lung disease associated with rheumatoid arthritis (RA-ILD). Recent findings: Over the past year, many studies replicated previous findings in more diverse and occasionally larger populations internationally. Specifically, the association among cigarette smoking, high rheumatoid factor titer, elevated anticitrullinated protein antibody (ACPA) levels, and RA-ILD was strengthened. Clinical characteristics, autoantibodies, and biomarkers to aid in RA-ILD development, progression, and mortality prediction were explored. Finally, direct and indirect treatment effects were highlighted. Summary: The ability to identify risk factors for preclinical RA-ILD has been enhanced, but the proper management strategy for these patients is yet to be defined. ACPAs and cigarette smoking are highly associated with RA-ILD, but the mechanistic relationship between lung injury and autoantibody generation remains unknown. There is conflicting evidence regarding the significance of a usual interstitial pneumonia (UIP) versus non-UIP pattern on high-resolution computed tomography. The use of biologic agents in patients with rheumatoid arthritis does not appear to increase the risk of incident ILD or RA-ILD exacerbation. Randomized prospective studies of specific therapy for RA-ILD are still lacking.
AB - Purpose of review: To provide an overview of recently published articles covering interstitial lung disease associated with rheumatoid arthritis (RA-ILD). Recent findings: Over the past year, many studies replicated previous findings in more diverse and occasionally larger populations internationally. Specifically, the association among cigarette smoking, high rheumatoid factor titer, elevated anticitrullinated protein antibody (ACPA) levels, and RA-ILD was strengthened. Clinical characteristics, autoantibodies, and biomarkers to aid in RA-ILD development, progression, and mortality prediction were explored. Finally, direct and indirect treatment effects were highlighted. Summary: The ability to identify risk factors for preclinical RA-ILD has been enhanced, but the proper management strategy for these patients is yet to be defined. ACPAs and cigarette smoking are highly associated with RA-ILD, but the mechanistic relationship between lung injury and autoantibody generation remains unknown. There is conflicting evidence regarding the significance of a usual interstitial pneumonia (UIP) versus non-UIP pattern on high-resolution computed tomography. The use of biologic agents in patients with rheumatoid arthritis does not appear to increase the risk of incident ILD or RA-ILD exacerbation. Randomized prospective studies of specific therapy for RA-ILD are still lacking.
KW - Interstitial lung disease
KW - Pathogenesis
KW - Pulmonary fibrosis
KW - Rheumatoid arthritis
KW - Treatment
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U2 - 10.1097/BOR.0000000000000380
DO - 10.1097/BOR.0000000000000380
M3 - Review article
C2 - 28207496
AN - SCOPUS:85013106614
SN - 1040-8711
VL - 29
SP - 254
EP - 259
JO - Current Opinion in Rheumatology
JF - Current Opinion in Rheumatology
IS - 3
ER -