Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Rheumatol. Mar 12, 2015; 5(1): 1-22
Published online Mar 12, 2015. doi: 10.5499/wjr.v5.i1.1
Interstitial lung disease in rheumatoid arthritis: Current concepts in pathogenesis, diagnosis and therapeutics
Eva M Olivas-Flores, David Bonilla-Lara, Jorge I Gamez-Nava, Alberto D Rocha-Muñoz, Laura Gonzalez-Lopez
Eva M Olivas-Flores, Hospital General Regional 180 Instituto Mexicano del Seguro Social (IMSS), Tlajomulco 45640, Mexico
David Bonilla-Lara, Jorge I Gamez-Nava, Alberto D Rocha-Muñoz, Laura Gonzalez-Lopez, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara, Jalisco 44280, Mexico
Jorge I Gamez-Nava, Hospital de Especialidades Centro Medico Nacional de Occidente, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco 44340, Mexico
Laura Gonzalez-Lopez, Hospital General Regional 110 Departamento de Medicina Interna-Reumatologia, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco 48520, Mexico
Author contributions: All the authors equally contributed to this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Laura Gonzalez-Lopez, MD, MSc, PhD, Hospital General Regional 110 Departamento de Medicina Interna-Reumatologia, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco 48520, Mexico.
Telephone: +52-33-38541369
Received: July 21, 2014
Peer-review started: July 22, 2014
First decision: July 22, 2014
Revised: September 27, 2014
Accepted: December 10, 2014
Article in press: December 10, 2014
Published online: March 12, 2015

Rheumatoid arthritis (RA) is the most common chronic autoimmune inflammatory joint disease. RA-associated interstitial lung disease (RA-ILD) is a major extra-articular complication and causes symptoms that lead to a deterioration in the quality of life, high utilization of health resources, and an increased risk of earlier mortality. Early in the course of RA-ILD, symptoms are highly variable, making the diagnosis difficult. Therefore, a rational diagnostic strategy that combines an adequate clinical assessment with the appropriate use of clinical tests, including pulmonary function tests and high-resolution computed tomography, should be used. In special cases, lung biopsy or bronchioalveolar lavage should be performed to achieve an early diagnosis. Several distinct histopathological subtypes of RA-ILD are currently recognized. These subtypes also have different clinical presentations, which vary in therapeutic response and prognosis. This article reviews current evidence about the epidemiology of RA-ILD and discusses the varying prevalence rates observed in different studies. Additionally, aspects of RA-ILD pathogenesis, including the role of cytokines and other molecules such as autoantibodies, as well as the evidence linking several drugs used to treat RA with lung damage will be discussed. Some aspects of the clinical characteristics of RA-ILD are noted, and diagnostic strategies are reviewed. Finally, this article analyzes current treatments for RA-ILD, including immunosuppressive therapies and biologic agents, as well as other therapeutic modalities. The prognosis of this severe complication of RA is discussed. Additionally, this paper examines updated evidence from studies identifying an association between drugs used for the treatment of RA and the development of ILD.

Keywords: Rheumatoid arthritis, Interstitial lung disease, Pathogenesis, Diagnosis, Therapeutic

Core tip: This review analyzes current evidence regarding the epidemiology, pathogenesis, diagnosis and treatment of interstitial lung disease associated with rheumatoid arthritis (RA-ILD). Data regarding differences in the prevalence of RA-ILD in different populations are presented. Updates regarding the pathogenesis of RA-ILD, including genetics, environmental factors, cytokines and autoantibodies, are presented. The paper also reviews the different tests used to diagnose RA-ILD, describes RA-ILD treatment, and discusses studies that were designed to identify a therapeutic response to immunosuppressive drugs or biological agents.