Interstitial lung disease in rheumatoid arthritis – current events

Rheumatoid arthritis (RA) is an autoimmune inflammatory joint disease with a chronic-progressive course. It occurs with progressive, symmetrical, erosive arthritis and extraarticular manifestations. The incidence of RA is 1 - 2% of the population. It affects women and men in a ratio of 9:1. Extra-articular manifestations are found in about 50% of patients with RA: consumptive and astheno-adynamic syndrome, splenomegaly, pericarditis, vasculitis, subcutaneous nodules, pulmonary involvement. Pulmonary involvement is found in 4 to 68% of patients with RA. The earliest pulmonary complications are respiratory manifestations – interstitial lung disease (ILD), bronchiolitis and cylindrical bronchiectasis. ILD in the course of rheumatoid arthritis occurs twice as often in men between 50 and 60 years of age. Several studies confirm that the most common radiographic presentation of ILD in patients with RA is usual interstitial pneumonia (UIP), with peripheral reticular opacities and honeycombing seen on high-resolution computed tomography (HRCT). Important for the occurrence, clinical course, and prevention of pulmonary fibrosis manifestations is to assess the presence of biomarkers in the serum of these patients with rheumatoid arthritis. 98 articles were found investigating biomarkers in interstitial lung disease associated with rheumatoid arthritis (ILD-RA), with 83 studies being of high quality, 15 being of moderate quality. The biomarkers studied were C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), anti-cyclic citrullinated antibody (anti-CCP), rheumatoid factor (RF), Krebs von den Lungen 6 (KL-6), surfactant protein D (SP-D), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9. (CA19-9), matrix metalloproteinase 7 (MMP-7), chemokine ligand 10 (CXCL-10), neutrophil to lymphocyte ratio (NLR) in patients with rheumatoid arthritis only and in patients with ILD-RA. Treatment of the disease includes corticosteroids, immunosuppressants, biological therapy, kinase inhibitors. These medications are used to treat not only rheumatoid arthritis, but also systemic manifestations.