Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
Drugs. 2014 Mar;74(4):443-50. doi: 10.1007/s40265-014-0190-z.
Rheumatoid arthritis (RA) is an inflammatory autoimmune disease characterized by the destruction of articular joint structures. RA is a systemic condition that often affects multiple organs, including the heart, lungs, and kidneys. Pulmonary complications of RA are relatively common and include pleural effusion, rheumatoid nodules, bronchiectasis, obliterative bronchiolitis, and opportunistic infections. Interstitial lung disease (ILD) is a common occurrence in patients with RA, and can range in severity from an asymptomatic incidental finding to a rapidly progressing life-threatening event. Usual interstitial pneumonia and non-specific interstitial pneumonia are the two most common patterns, though others have been reported. Various disease-modifying anti-rheumatic drugs-in particular, methotrexate and the tumor necrosis factor-alpha inhibitors-have been associated with RA-ILD in numerous case reports and case series, though it is often difficult to distinguish association from causality. Treatment for RA-ILD typically involves the use of high-dose corticosteroids, often in conjunction with alternative immunosuppressant agents such as azathioprine or mycophenolate mofetil, and outcomes vary widely depending on the initial pattern of lung disease. Additional research into the mechanisms driving RA-ILD is needed to guide future therapy.
类风湿关节炎（RA）是一种以关节结构破坏为特征的炎症性自身免疫性疾病。RA 是一种全身性疾病，常累及多个器官，包括心脏、肺和肾脏。RA 的肺部并发症较为常见，包括胸腔积液、类风湿结节、支气管扩张、闭塞性细支气管炎和机会性感染。间质性肺疾病（ILD）是 RA 患者的常见病症，其严重程度可从无症状的偶发发现到迅速进展的危及生命的事件不等。常见间质性肺炎和非特异性间质性肺炎是两种最常见的类型，但也有其他类型的报道。在许多病例报告和病例系列中，各种疾病修饰抗风湿药物-特别是甲氨蝶呤和肿瘤坏死因子-α抑制剂-与 RA-ILD 相关，但通常很难将相关性与因果关系区分开来。RA-ILD 的治疗通常包括使用大剂量皮质类固醇，通常与替代免疫抑制剂（如硫唑嘌呤或霉酚酸酯）联合使用，并且初始肺疾病的模式决定了预后的差异很大。需要进一步研究驱动 RA-ILD 的机制，以指导未来的治疗。
