Liang Minrui, Matteson Eric L, Abril Andy, Distler Jörg H W
Rheumatology and Clinical Immunology, Department of Internal Medicine 3, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany.
Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
Ther Adv Musculoskelet Dis. 2022 Feb 15;14:1759720X221074457. doi: 10.1177/1759720X221074457. eCollection 2022.
The major pulmonary complication of rheumatoid arthritis (RA) is interstitial lung disease (ILD), which causes significant morbidity and mortality and influences the natural course of disease. Recent advances in the management of arthritis have improved patient outcomes. However, exceptionally high medical needs still remain for effective therapies for the patients with ILD in RA. Better understanding of the shared and distinct pathophysiology of fibrotic diseases led to the development of novel antifibrotic agents such as nintedanib and pirfenidone. The further stratification analysis of the phase III INBUILD trial demonstrated beneficial effects of nintedanib in RA-ILD with a progressive phenotype by reducing the rate of decline in forced vital capacity (FVC) over 52 weeks by 60%. Pirfenidone is another antifibrotic agent currently under phase II clinical study (TRAIL1) aiming to evaluate its effects for RA-ILD. This review provides an overview of state-of-the-art pathogenesis and the current therapeutic options for RA-ILD, with a focus on antifibrotic strategies.
类风湿关节炎（RA）的主要肺部并发症是间质性肺疾病（ILD），它会导致显著的发病率和死亡率，并影响疾病的自然进程。关节炎治疗方面的最新进展改善了患者的预后。然而，对于RA合并ILD患者的有效治疗，仍然存在极高的医疗需求。对纤维化疾病共同和独特病理生理学的更好理解，促使了诸如尼达尼布和吡非尼酮等新型抗纤维化药物的研发。III期INBUILD试验的进一步分层分析表明，尼达尼布对具有进展性表型的RA-ILD有益，可使52周内用力肺活量（FVC）的下降率降低60%。吡非尼酮是另一种目前正在进行II期临床研究（TRAIL1）的抗纤维化药物，旨在评估其对RA-ILD的疗效。本综述概述了RA-ILD的最新发病机制和当前治疗选择，重点是抗纤维化策略。
