The Lung in RA: Little Progress 'Still a bit of a mess'

The progress that has been seen in the management of many aspects of rheumatoid arthritis (RA) has not been paralleled for the pulmonary disease that remains the second most common cause of death among these patients, an Australian expert reported here at the annual meeting of the Florida Society of Rheumatology. Many of the other extra-articular components of RA such as ocular disease and vasculitis have "essentially disappeared," and the goal for joint symptoms today is remission, but pulmonary disease in RA actually appears to be on the rise, said Andrew Ostor, MD, of Cabrini Medical Center in Melbourne, Victoria. The reasons for that may include patients' increased longevity, better methods of detection, and the effects of treatment, he noted. In addition, dyspnea is replacing pain and stiffness as a barrier to mobility, and so is being reported more often by patients. RA-associated interstitial lung disease (ILD) is a progressive, although potentially reversible, fibrotic lung disease of the parenchyma. Very little is known about its pathogenesis, and conflicting views exist on everything from epidemiology to management, he observed. Postmortem studies have detected lung disease in up to 80% of patients, and changes on chest x-rays are seen in 30%-50% of cases. Clinically significant disease is present in approximately one in 10 patients, and is associated with considerable morbidity. The most common subtype is usual interstitial pneumonia, representing two-thirds of cases and characterized by fibrosis and honeycombing, while nonspecific interstitial pneumonia, with variable levels of alveolitis and inflammation, is present in one-quarter of cases. Abatacept (Orencia), however, has shown promise as a safe option, and a clinical trial to evaluate this agent in RA-ILD is in the planning stages. Other treatments have derived from different patient groups, such as steroids, azathioprine, and pirfenidone (Esbriet) used in idiopathic pulmonary fibrosis, and cyclophosphamide or mycophenolate mofetil (Cellcept) used for scleroderma ILD. "So the take-home message is that pulmonary disease in RA is still a bit of a mess, and we have a long way to go. It's complicated, there is no established therapy or validated trials, and there are possible confounding factors such as infection. Treatment must be individualized," he concluded. https://www.medpagetoday.com/meetingcoverage/fsr/74069?xid=nl_mpt_hemoncvideo_2018-07-18&eun=g721819d0r&pos=2&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%202018-07-18&utm_term=Daily%20Headlines%20-%20Active%20User%20-%20180%20days