Choroba śródmiąższowa płuc związana z reumatoidalnym zapaleniem stawów – niedoceniany, złożony i interdyscyplinarny problem w codziennej praktyce klinicznej

Abstract

Rheumatoid arthritis (RA) is a chronic, systemic inflammatory connective tissue disease affecting 0.5–1% of the general population. Interstitial lung disease (ILD) is a serious complication of RA, leads to a deterioration in the quality of life, increases the risk of hospitalization and premature death. The clinical course of RA-associated ILD (RA-ILD) varies from interstitial lesions involving little areas of the lung which do not lead to clinical symptoms, to progressive interstitial lesions that may lead to acute respiratory exacerbation, development of respiratory failure, and death. The main risk factor for the development of ILD in the course of RA, apart from older age and male sex, is the high activity of the underlying disease. Effective treatment of RA, aimed at the goal of remission, may therefore be a preventive method for the development of RA-ILD. Due to non-specific symptoms, the diagnosis of RA-ILD is often overlooked. Despite significant morbidity and increased risk of death due to RA-ILD, currently, we do not have any guidelines on the management of this clinical situation. Moreover, the problem is even more complicated due to the possibility of potential pneumotoxicity of many disease-modifying drugs and their unclear effectiveness regarding lung involvement in RA. Taken together, optimal management of a patient with RA-ILD is a clinical challenge. There is an urgent need to clarify several clinical aspects concerning the early diagnosis, monitoring, establishing indications for treatment, and choice of appropriate therapeutic management. In this work, we performed a scientific review of the current state of knowledge on RA-ILD and indicated the directions of future research needed aiming at improving patients’ care.