Bluett James, Jani Meghna, Symmons Deborah P M
Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Division of Dermatological and Musculoskeletal Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Rheumatol Ther. 2017 Dec;4(2):309-332. doi: 10.1007/s40744-017-0071-5. Epub 2017 Aug 14.
Lung disease is one of the most common causes of extra-articular morbidity and mortality in patients with rheumatoid arthritis (RA). Development of pulmonary manifestations may be due to the systemic disease itself; to serious respiratory adverse events such as pneumonitis and infections secondary to therapy; or to lifestyle habits such as smoking. Rheumatologists often need to make important treatment decisions and plan future care in RA patients with respiratory comorbidities, despite the absence of clear evidence or consensus. In this review we evaluate the clinical assessment and management of RA-associated interstitial lung disease, bronchiectasis, serious (including opportunistic) infection, and smoking-related diseases. We summarize the international recommendations for the management of such conditions where available, refer to published best practice on the basis of scientific literature, and propose practical management suggestions to aid informed decision-making.
肺部疾病是类风湿关节炎（RA）患者关节外发病和死亡的最常见原因之一。肺部表现的出现可能归因于全身性疾病本身；归因于严重的呼吸道不良事件，如肺炎和治疗继发的感染；或归因于吸烟等生活习惯。尽管缺乏明确的证据或共识，但风湿病学家经常需要对患有呼吸系统合并症的RA患者做出重要的治疗决策并规划未来的护理。在本综述中，我们评估了RA相关的间质性肺疾病、支气管扩张、严重（包括机会性）感染和吸烟相关疾病的临床评估和管理。我们总结了现有国际上针对此类病症管理的建议，参考基于科学文献发表的最佳实践，并提出实用的管理建议以帮助做出明智的决策。
