Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease: Lights and Shadows
Rheumatoid arthritis (RA) is a chronic and systemic inflammatory disease affecting 0.5–1% of the population worldwide. Interstitial lung disease (ILD) is a serious pulmonary complication of RA and it is responsible for 10–20% of mortality, with a mean survival of 5–8 years. However, nowadays there a...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/4/1082 |
| _version_ | 1797570951938834432 |
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| author | Giulia Cassone Andreina Manfredi Caterina Vacchi Fabrizio Luppi Francesca Coppi Carlo Salvarani Marco Sebastiani |
| author_facet | Giulia Cassone Andreina Manfredi Caterina Vacchi Fabrizio Luppi Francesca Coppi Carlo Salvarani Marco Sebastiani |
| author_sort | Giulia Cassone |
| collection | DOAJ |
| description | Rheumatoid arthritis (RA) is a chronic and systemic inflammatory disease affecting 0.5–1% of the population worldwide. Interstitial lung disease (ILD) is a serious pulmonary complication of RA and it is responsible for 10–20% of mortality, with a mean survival of 5–8 years. However, nowadays there are no therapeutic recommendations for the treatment of RA-ILD. Therapeutic options for RA-ILD are complicated by the possible pulmonary toxicity of many disease modifying anti-rheumatic drugs (DMARDs) and by their unclear efficacy on pulmonary disease. Therefore, joint and lung involvement should be evaluated independently of each other for treatment purposes. On the other hand, some similarities between RA-ILD and idiopathic pulmonary fibrosis and the results of the recent INBIULD trial suggest a possible future role for antifibrotic agents. From this perspective, we review the current literature describing the pulmonary effects of drugs (immunosuppressants, conventional, biological and target synthetic DMARDs and antifibrotic agents) in patients with RA and ILD. In addition, we suggest a framework for the management of RA-ILD patients and outline a research agenda to fill the gaps in knowledge about this challenging patient cohort. |
| first_indexed | 2024-03-10T20:32:43Z |
| format | Article |
| id | doaj.art-25ff3a57500a43dcbe0c5d5df0510858 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T20:32:43Z |
| publishDate | 2020-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-25ff3a57500a43dcbe0c5d5df05108582023-11-19T21:16:08ZengMDPI AGJournal of Clinical Medicine2077-03832020-04-0194108210.3390/jcm9041082Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease: Lights and ShadowsGiulia Cassone0Andreina Manfredi1Caterina Vacchi2Fabrizio Luppi3Francesca Coppi4Carlo Salvarani5Marco Sebastiani6Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, ItalyChair and Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41124 Modena, ItalyClinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, ItalyRespiratory Unit, University of Milano Bicocca, S. Gerardo Hospital, 20900 Monza, ItalyDepartment of Cardiology, University of Modena and Reggio Emilia, Azienda Ospedaliero-Univesitaria Policlinico di Modena, 41124 Modena, ItalyChair and Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41124 Modena, ItalyChair and Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41124 Modena, ItalyRheumatoid arthritis (RA) is a chronic and systemic inflammatory disease affecting 0.5–1% of the population worldwide. Interstitial lung disease (ILD) is a serious pulmonary complication of RA and it is responsible for 10–20% of mortality, with a mean survival of 5–8 years. However, nowadays there are no therapeutic recommendations for the treatment of RA-ILD. Therapeutic options for RA-ILD are complicated by the possible pulmonary toxicity of many disease modifying anti-rheumatic drugs (DMARDs) and by their unclear efficacy on pulmonary disease. Therefore, joint and lung involvement should be evaluated independently of each other for treatment purposes. On the other hand, some similarities between RA-ILD and idiopathic pulmonary fibrosis and the results of the recent INBIULD trial suggest a possible future role for antifibrotic agents. From this perspective, we review the current literature describing the pulmonary effects of drugs (immunosuppressants, conventional, biological and target synthetic DMARDs and antifibrotic agents) in patients with RA and ILD. In addition, we suggest a framework for the management of RA-ILD patients and outline a research agenda to fill the gaps in knowledge about this challenging patient cohort.https://www.mdpi.com/2077-0383/9/4/1082rheumatoid arthritisinterstitial lung diseasetherapyDMARDsantifibrotic agents |
| spellingShingle | Giulia Cassone Andreina Manfredi Caterina Vacchi Fabrizio Luppi Francesca Coppi Carlo Salvarani Marco Sebastiani Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease: Lights and Shadows Journal of Clinical Medicine rheumatoid arthritis interstitial lung disease therapy DMARDs antifibrotic agents |
| title | Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease: Lights and Shadows |
| title_full | Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease: Lights and Shadows |
| title_fullStr | Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease: Lights and Shadows |
| title_full_unstemmed | Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease: Lights and Shadows |
| title_short | Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease: Lights and Shadows |
| title_sort | treatment of rheumatoid arthritis associated interstitial lung disease lights and shadows |
| topic | rheumatoid arthritis interstitial lung disease therapy DMARDs antifibrotic agents |
| url | https://www.mdpi.com/2077-0383/9/4/1082 |
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