Introduction:
Lung involvement is rheumatoid arthritis's (RA) most frequent extra-articular symptom. RA is a systemic inflammatory disease. Interstitial lung disease (ILD), pleural effusion, cricoarytenoiditis, constrictive or follicular bronchiolitis, bronchiectasis, pulmonary vasculitis, and pulmonary hypertension are just a few of the manifestations that can affect any of the lung compartments. However, RA-ILD is a major cause of death for patients with RA and is linked to a significant morbidity and mortality rate. In this study, earlier research on the subject concentrated on the frequent pulmonary symptoms of RA, RA-ILD, and airway illness. Scientists also discussed developing hypotheses in the pathophysiology of RA-associated pulmonary fibrosis and therapeutic methods. Included is a logical clinical approach to the diagnosis and treatment of RA-ILD, as well as a strategy for treating individuals whose condition worsens while individuals receive medication to modify it. In the field of RA-associated pulmonary illness, research priorities and unmet needs are discussed.
What Is Interstitial Lung Disease Related to Rheumatoid Arthritis?
Rheumatoid arthritis-associated interstitial lung disease, or "RA-ILD," is a chronic lung illness in which an individual with a diagnosis of rheumatoid arthritis experiences an accumulation of scar tissue (also known as "fibrosis") and/or inflammation in the walls of their lungs' air sacs.
The "autoimmune" disease known as rheumatoid arthritis, or "RA," is one. The term "autoimmune" refers to conditions in which inflammation and other issues are brought on by the immune system within the body's organs. Other than RA, numerous other autoimmune illnesses can occur, such as scleroderma, dermatomyositis, and systemic lupus erythematosus. In addition to its primary cause of arthritis, rheumatoid arthritis (RA) can induce lung disease, nerve or vision issues, and various forms of inflammation throughout the body.
Many individuals with RA do not have lung disease. When RA does affect the lungs, it can cause a variety of lung conditions. The most common issue in RA-affected individuals' lungs is interstitial lung disease (ILD). Other conditions that RA can cause include lung nodules (also called "pulmonary nodules"), difficulties with the lung's airways, and issues with the lung's outer lining (also called "pleural disease"). Individuals taking certain medications for RA may experience side effects that affect the lungs, such as lung infections (due to a weakened immune system) and even ILD as a result of medication use.
What Ra-ILD Symptoms Are Present?
Individuals suffering from RA-ILD may experience symptoms associated with lung and joint issues. Most individuals with early RA-ILD will not have any respiratory symptoms in the lungs, though they may have a troublesome cough. Breathlessness during exercise and ordinary activities becomes common as the condition advances. Anxiety, despair, and exhaustion are also prevalent.
Why Does Ra-Ild Occur?
Nobody knows for sure what causes RA or RA-ILD. Smoking and specific genetic alterations in the "human leukocyte antigen," or "HLA," gene family are two risk factors for RA. According to a notion, pulmonary inflammation may initiate RA, which means that for certain individuals, the illness may begin in the lungs before moving to the joints. Smoking is the main risk factor for developing ILD in RA patients. An additional risk factor for ILD is gender, with men and more severe RA patients being the most affected.
How to Diagnose Ra-Ild?
Tests that may be conducted by a physician or other healthcare professional who suspects a patient has ILD include blood work, pulmonary function testing, chest X-rays, and high-resolution CT scans (also referred to as CAT scans). The capacity of the lungs to hold air is measured by pulmonary function testing. The lungs' capacity to contain air decreases with the amount of scar tissue present. Additionally, a physician may employ a specialized form of chest X-ray known as a high-resolution computed tomography (HRCT) scan, which provides finely detailed images of the lung. On a CT scan, healthy lung tissue appears almost black. Both inflammation and scar tissue have a gray or white appearance.
An essential indicator of RA's existence would be joint pain, stiffness, and edema. Blood tests that detect the presence of RA include "anti-cyclic citrullinated peptide antibody" (also known as "anti-CCP") and "rheumatoid factor" (also known as "RF"). A rheumatologist who specializes in autoimmune disorders would typically assist in making an accurate diagnosis of RA.
What Is the Treatment for Ra-Ild?
It is critical to perform a baseline evaluation of disease severity in individuals diagnosed with RA-ILD and to closely monitor these patients in order to identify those who experience disease progression. When determining whether to start or increase ongoing treatment for individuals with RA-ILD, two important aspects to take into account are the severity and course of the disease. Clinical evaluations of these variables can be conducted utilizing subjective assessments of deteriorating symptoms, a decrease in pulmonary function tests (PFTs), or radiologic deterioration. It is important to consider additional patient-specific characteristics such as age, comorbidities, UIP or non-UPI patterns, and patient preferences, given there are currently no randomized controlled trials (RCTs) to support evidence-based therapy decision-making.
There is no FDA-approved treatment for RA-ILD, and there are no accepted medical practices for its management. Lung inflammation can sometimes be treated with drugs that compromise immunological function. Doctors may choose to monitor a patient's condition without prescribing medicine. Treatments for RA-related joint disease may not always address lung problems.
For certain RA-ILD patients, lung transplantation is an appropriate course of treatment. Since the procedure entails several consultations to teach the patient about transplantation and assess their suitability, early evaluation for lung transplantation is crucial.
Important aspects of life include pulmonary rehabilitation, extra oxygen, quitting smoking, and routine immunizations (such as the influenza and pneumonia vaccines).
Conclusion:
Patients with rheumatoid arthritis frequently experience lung involvement, which can take many different forms. The most prevalent ones are ILD, pleural disease, and pulmonary medication toxicity. Lung damage mechanisms have been linked to drugs, environmental exposure, and genetics. Patients with pulmonary disease may not exhibit any symptoms at all, but it is possible for them to develop before other rheumatoid arthritis symptoms, such as articular involvement, show. The pulmonary illness linked with rheumatoid arthritis carries a high overall morbidity and mortality rate. Since there are currently no prospective randomized clinical studies for RA-ILD, immunomodulating medications used for treating rheumatoid arthritis, in general, remain the mainstay of treatment for RA-ILD. More investigation is required to identify certain risk factors and suitable treatment.
