Department of Rheumatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Division of Pulmonary Medicine, Department of Medicine, Chongqing General Hospital, Chongqing, China.
Nat Rev Rheumatol. 2019 Oct;15(10):581-596. doi: 10.1038/s41584-019-0275-x. Epub 2019 Aug 27.
Rheumatoid arthritis (RA) is a chronic autoimmune disorder that causes joint inflammation and damage. Extra-articular manifestations occur in many patients and can include lung involvement in the form of airway or parenchymal inflammation and fibrosis. Although the pathophysiology of articular RA has been extensively investigated, the mechanisms causing airway and parenchymal lung disease are not well defined. Infections, cigarette-smoking, mucosal dysbiosis, host genetics and premature senescence are all potentially important contributors to the development of lung disease in patients with RA. RA-associated lung disease (which can predate the onset of articular disease by many years) probably originates from chronic airway and alveolar epithelial injury that occurs in an individual with a genetic background that permits the development of autoimmunity, leading to chronic inflammation and subsequent airway and lung parenchymal remodelling and fibrosis. Further investigations into the specific mechanisms by which lung disease develops in RA will be crucial for the development of effective therapies. Identifying mechanisms by which environmental and host factors cooperate in the induction of autoimmunity in the lung might also help to establish the order of early events in RA.
类风湿关节炎（RA）是一种慢性自身免疫性疾病，可导致关节炎症和损伤。许多患者会出现关节外表现，包括肺部受累，表现为气道或实质炎症和纤维化。虽然关节 RA 的病理生理学已得到广泛研究，但导致气道和肺实质疾病的机制尚不清楚。感染、吸烟、黏膜失调、宿主遗传学和过早衰老都是导致 RA 患者肺部疾病发展的潜在重要因素。RA 相关的肺部疾病（可能在关节疾病发病前多年就已出现）可能源自个体慢性气道和肺泡上皮损伤，这种损伤发生在允许自身免疫发展的遗传背景下，导致慢性炎症以及随后的气道和肺实质重塑和纤维化。进一步研究 RA 中肺部疾病发展的具体机制对于开发有效的治疗方法至关重要。确定环境和宿主因素在肺部诱导自身免疫中的协同作用机制，也有助于确定 RA 中早期事件的顺序。
