Decision-Making Strategy for the Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD).
Hideaki YamakawaTakashi OguraHideto KamedaTomoo KishabaTae IwasawaTamiko TakemuraKazuyoshi KuwanoPublished in: Journal of clinical medicine (2021)
Rheumatoid arthritis (RA) is a common type of autoimmune arthritis. Patient clinical outcomes might be influenced by numerous respiratory diseases, but interstitial lung disease (ILD) is the most important comorbidity. RA-associated ILD (RA-ILD) is divided into acute/subacute and chronic forms. In the acute/subacute course, if the disease is severe as indicated by a diffuse alveolar damage pattern, high-dose corticosteroids combined with antimicrobial agents should be promptly initiated while considering the differential diagnoses, primarily acute exacerbation (AE) of RA-ILD, drug-induced pneumonitis, and Pneumocystis pneumonia. As initial therapeutic management in the chronic course, the RA itself should be stabilized without delay; thereafter, the activity of ILD itself can be stabilized, considering the safety of each anti-rheumatic drug. The formation of the usual interstitial pneumonia (UIP) pattern is the most important determinant because lung function can worsen more quickly with this pattern. However, because clinicians can fail to identify specific radiological patterns, it is important to determine whether each patient with RA-ILD has UIP-like lesions such as subpleural reticulation, traction bronchiectasis, and honeycombing especially progressively enlarged cysts. In patients with progressive RA-ILD and high risk for infection or AE of ILD in whom fibrosis is dominant, clinicians should consider starting an anti-fibrotic agent.
Keyphrases
- interstitial lung disease
- rheumatoid arthritis
- drug induced
- liver injury
- systemic sclerosis
- disease activity
- respiratory failure
- idiopathic pulmonary fibrosis
- lung function
- ankylosing spondylitis
- liver failure
- chronic obstructive pulmonary disease
- high dose
- decision making
- cystic fibrosis
- palliative care
- case report
- adverse drug
- low dose
- emergency department
- mechanical ventilation
- intensive care unit
- oxidative stress