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Rheumatoid arthritis commonly affects the lungs and can involve any compartment of the respiratory system.
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Usual interstitial pneumonia and nonspecific interstitial pneumonia are the most common patterns seen with interstitial involvement in rheumatoid arthritis.
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Treatment consists of long-term therapy with immunomodulatory agents.
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Further studies are needed to better characterize patients, predict progression, and determine optimal therapeutic regimens.
Lung Disease in Rheumatoid Arthritis
Section snippets
Key points
Epidemiology
RA is the most common connective tissue disease (CTD), with a prevalence of 0.5% to 2% in the general population.2 The disease occurs more frequently in women than in men with a ratio of 3:1. Extra-articular disease occurs in approximately 50% of patients, with the lung being a common site of involvement.3 Lung involvement may occur in as many as 67% of patients, although some reports indicate a lower incidence (around 10%–20%).4, 5, 6 This wide variation reflects differences in study design,
Interstitial Lung Disease
ILD refers to heterogeneous group of parenchymal lung disorders classified by distinct clinical, pathologic, and radiographic features. The 2013 American Thoracic Society/European Respiratory Society official classification of the idiopathic interstitial pneumonias (IIPs) outlines the most recent histopathologic classifications of ILD, many of which may be seen in RA.12 The most common forms of ILD associated with RA are usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia
Future considerations/Summary
RA is a common disorder with a myriad of pulmonary manifestations. Although any compartment of the respiratory system is at risk, the ILDs cause the greatest concern. In its most severe form, affected patients can develop a fibrotic ILD with progression similar to that seen in IPF. Treatment is based on expert opinion and there are no placebo-controlled trials. In order to effectively care for these patients, a better understanding is needed of the link between synovitis and pulmonary disease.
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Disclosure: NIH Diversity Supplement 3R01 HL109517–01A1S1.