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Management of Rheumatoid Arthritis Patients with Interstitial Lung Disease:
Safety of Biological Antirheumatic Drugs and Assessment of Pulmonary Fibrosis
#MMPMID26401101
Mori S
Clin Med Insights Circ Respir Pulm Med
2015[]; 9
(Suppl 1
): 41-9
PMID26401101
show ga
Interstitial lung disease (ILD) is one of the major causes of morbidity and
mortality of patients with rheumatoid arthritis (RA). Accompanying the increased
number of reports on the development or exacerbation of ILD in RA patients
following therapy with biological disease-modifying antirheumatic drugs (DMARDs),
RA-associated ILD (RA-ILD) has aroused renewed interest. Although such cases have
been reported mainly in association with the use of tumor necrosis factor
inhibitors, the use of other biological DMARDs has also become a matter of
concern. Nevertheless, it is difficult to establish a causative relationship
between the use of biological DMARDs and either the development or exacerbation
of ILD. Such pulmonary complications may occur in the natural course of RA
regardless of the use of biological DMARDs. Since rheumatologists currently aim
to achieve remission in RA patients, the administration of biological DMARDs is
increasing, even for those with RA-ILD. However, there are no reliable,
evidence-based guidelines for deciding whether biological DMARDs can be safely
introduced and continued in RA-ILD patients. A standardized staging system for
pulmonary conditions of RA-ILD patients is needed when making therapeutic
decisions at baseline and monitoring during biological DMARD therapy. Based on
the available information regarding the safety of biological DMARDs and the
predictive factors for a worse prognosis, this review discusses candidate
parameters for risk evaluation of ILD in RA patients who are scheduled to receive
biological antirheumatic therapy.