Rheumatoid Arthritis and Associated Lung Diseases: A Comprehensive Review

Ahmad T Azam,Oladipo Odeyinka,Rasha Alhashimi,Sankeerth Thoota,Vishnu Palyam,Tejaswini Ashok,Ibrahim Sange

doi:10.7759/cureus.22367

Abstract

Rheumatoid arthritis (RA) is a prevalent autoimmune disorder affecting 0.5-1% of the population in North America and Europe. Pulmonary manifestations in rheumatoid arthritis patients result in significant morbidity and mortality. Management of these pulmonary manifestations in RA patients causes various challenges for the physicians. This review article has discussed the current state of knowledge of these pulmonary manifestations, including interstitial lung diseases, airway-related diseases, pulmonary vasculature, and pleural involvement in RA patients. This review article has also explored various pharmacological options, including steroids, disease-modifying antirheumatic drugs (DMARDs), immunosuppressive drugs, and biologic agents. Non-pharmacological options include conservative treatment, supplemental oxygen, pulmonary rehabilitation, smoking cessation, and lung transplantation.

Highlights

BackgroundRheumatoid arthritis (RA) is one of the most prevalent chronic inflammatory diseases characterized by progressive autoimmune and inflammatory damage to cartilage, bones and synovial lining of the joints eventually resulting in the severe disability of the patient [1,2]
Monotherapy with methotrexate and corticosteroids is recommended as the first line of treatment for RA patients [21]
This study concluded that asymptomatic pulmonary manifestations, including Interstitial lung disease (ILD) that are only detectable by high-resolution computed tomography (HRCT), can be progressive in patients with RA [37]

Summary

Introduction

Rheumatoid arthritis (RA) is one of the most prevalent chronic inflammatory diseases characterized by progressive autoimmune and inflammatory damage to cartilage, bones and synovial lining of the joints eventually resulting in the severe disability of the patient [1,2]. Interstitial lung disease (ILD) is one of the most prevalent and well-studied pulmonary manifestations of rheumatoid arthritis [23]. This study concluded that asymptomatic pulmonary manifestations, including ILDs that are only detectable by HRCT, can be progressive in patients with RA [37]. Unlike other rheumatoid pulmonary manifestations, obliterative bronchiolitis usually has a more severe and acute clinical presentation It may present with cough, bronchorrhea, and rapidly progressive dyspnea without systemic symptoms. 97% of cases of ILD reported in the study were linked with the use of anti-TNF agents including etanercept and infliximab [73]. A prospective observational study by Dixon et al involving a sample population of 367 patients with RA-ILD demonstrated that the mortality rate was not increased after treatment with anti-TNF agents compared with traditional immunomodulatory drugs (Table 1) [74]. The evidence available regarding the efficacy of anti-TNF agents in RAILD patients is insufficient

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Disclosures