Narváez Javier
Department of Rheumatology, Hospital Universitario de Bellvitge & Bellvitge Biomedical Research Institute (IDIBELL), Feixa Llarga, s/n. Hospitalet de Llobregat, 08907 Barcelona, Spain.
J Clin Med. 2024 Sep 11;13(18):5385. doi: 10.3390/jcm13185385.
Patients with rheumatoid arthritis (RA) are at increased risk of developing interstitial lung disease compared to the general population, a complication that is associated with significant morbidity and high mortality. Given its frequency and severity, ILD should always be considered during both the initial assessment and follow-up of RA patients. However, there is currently no consensus on which RA patients should be screened for ILD. In recent years, several scientific societies have developed specific screening proposals. According to the recommendations of the Spanish, American, and Austrian rheumatology societies, it is not necessary to screen all individuals with RA, and it should be tailored to each patient based on clinical risk factors. In contrast, the Portuguese Societies of Rheumatology and Pulmonology advocate for systematic screening of all RA patients. Risk factors for the development of ILD in RA patients are well identified, and several screening tools for RA-ILD based on these risk factors have been developed. However, all of these tools still require further validation. To address this issue, the ANCHOR-RA study, a multinational cross-sectional initiative, has been launched to develop a multivariable model for predicting RA-ILD, which could provide valuable guidance for screening practices in clinical settings. In addition to certain biochemical and genetic predictive markers, lung ultrasound appears to be a useful screening tool. When combined with clinical evaluation and risk factor assessment, it can help identify which patients require a thoracic HRCT evaluation, which remains the gold standard for confirming an ILD diagnosis.
与普通人群相比，类风湿性关节炎（RA）患者发生间质性肺疾病的风险更高，这是一种与高发病率和高死亡率相关的并发症。鉴于其发生频率和严重程度，在对RA患者进行初始评估和随访时均应始终考虑ILD。然而，目前对于哪些RA患者应接受ILD筛查尚无共识。近年来，多个科学协会制定了具体的筛查建议。根据西班牙、美国和奥地利风湿病学会的建议，无需对所有RA患者进行筛查，而应根据临床风险因素对每位患者进行个性化筛查。相比之下，葡萄牙风湿病学会和肺病学会主张对所有RA患者进行系统性筛查。RA患者发生ILD的风险因素已得到明确识别，基于这些风险因素的多种RA-ILD筛查工具也已开发出来。然而，所有这些工具仍需进一步验证。为解决这一问题，已启动一项名为ANCHOR-RA的跨国横断面研究，以开发一种预测RA-ILD的多变量模型，该模型可为临床环境中的筛查实践提供有价值的指导。除了某些生化和基因预测标志物外，肺部超声似乎也是一种有用的筛查工具。当与临床评估和风险因素评估相结合时，它可以帮助确定哪些患者需要进行胸部高分辨率CT（HRCT）评估，而胸部HRCT仍然是确诊ILD的金标准。
