Cic edizioni internazionali
Shortness of Breath

Lung disease in rheumatoid arthritis.
Challenges and opportunities

Mini-Review, 2 - 9
doi: 10.11138/sob/2013.2.1.002
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The lungs and pleura are frequently sites of extra articular involvement in rheumatoid arthritis (RA).
Pleural disease and pulmonary nodules occur relatively frequently in the course of RA, and often are
manageable by medical or surgical approaches. RA patients may develop both obstructive and restrictive lung disease. Obstructive lung disease may develop due to bronchiectasis, small airway disease (constrictive and follicular bronchiolitis), and cricoarytenoid involvement. Restrictive lung disease due to a diffuse fibrotic interstitial pneumonia (usually caused by the usual interstitial pneumonia or the non-specific interstitial pneumonia patterns) occurs in around 17% of RA patients throughout the course of the disease. The treatment of RA-associated interstitial lung disease is challenging. Although immunosuppressive medications and cytotoxic agents are often used to treat RA-associated interstitial pneumonia, there is no convincing evidence that any of the available drugs alter disease course or improve lung function. RA-associated obstructive and restrictive lung diseases profoundly affect patient wellbeing, response to therapy, choice of immunosuppression, and overall survival.
Recent advances in the understanding of RA pathogenesis, the increased appreciation of cigarette smoke as a key predisposing factor of seropositive RA, and the emergence of novel biologic therapies hold promise for the development of more effective preventative and therapeutic strategies for lung complications in RA.