A recently published review in the journal Therapeutic Advances in Musculoskeletal Disease summarized the current state of clinical knowledge of rheumatoid arthritis-associated interstitial lung disease (RA-ILD).
The study, “Treatment of rheumatoid arthritis-associated interstitial lung disease: a perspective review,” was conducted by two researchers from the Department of Medicine at Queen Elizabeth Hospital in England, and aimed to discuss the current clinical and research literature, as well as assess recommendations for the management of RA-ILD and discuss key gaps in knowledge and understanding of the disease.
According to the authors, RA-ILD is an increasingly recognized and common complication that contributes significantly to overall morbidity and mortality in patients with rheumatoid arthritis (RA), but it is still poorly understood.
After reviewing the currently available literature, the authors’ findings included:
- Approximately one third of patients with RA will have evidence of subclinical ILD with a substantial minority progressing to clinically evident RA-ILD over time;
- RA-ILD has well-described subtypes that are shared with the idiopathic interstitial pneumonias (IIPs);
- Three main areas of importance have been identified for current and future translational research to focus on: subclinical RA-ILD, radiographic/histopathologic subtyping, and biomarker discovery;
- A better understanding of the clinical significance of subclinical RA-ILD as well as risk factors for its progression to clinically evident disease could allow targeted preventative interventions to be undertaken, and management of progressive subclinical disease;
- Better knowledge of the subtypes of RA-ILD as well as their similarities and differences to IPF could improve treatment and prognostic knowledge, as well as rationalize exploration of biologic mechanisms and drugs that have been previously identified in interstitial pulmonary fibrosis (IPF);
- Accurate and clinically practical biomarkers could allow prediction of individuals at high risk for future or progressive RA-ILD, enabling earlier diagnosis and treatment, as well as disease monitoring and measuring therapeutic response.
In a concluding statement, the authors wrote, “Current and future translational research should focus on improving awareness of the natural history and clarify the etiopathogenetic (causes based on pathology and genetics) cascade underlying the occurrence of RA-ILD, in order to design focused therapies, which are essential to both optimize the therapeutic approach of RA-ILD and to minimize the risk of its development in potentially predisposed patients … Addressing the current gaps in knowledge regarding pathogenesis, diagnosis and management of RA-ILD could substantially improve the lives of the not-inconsiderable numbers of patients with this debilitating condition.”