Matson Scott M
University of Kansas Medical Center, Department of Medicine, Division of Pulmonary, Critical Care and Sleep. 3901 Rainbow Blvd, Kansas City, Kansas, USA.
Curr Opin Pulm Med. 2025 Sep 1;31(5):518-525. doi: 10.1097/MCP.0000000000001190. Epub 2025 Jun 23.
Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) leads to poor survival, on average only 3-5 years from time of diagnosis. Despite its clinical impact, evidence-based treatment approaches remain limited, creating urgent clinical uncertainty about optimal management strategies. This review examines emerging precision medicine approaches that may guide more effective, individualized treatment decisions.
Current treatment paradigms based on radiologic patterns lack empirical validation, with recent evidence suggesting radiologic features poorly predict immunomodulatory response. Advances in RA joint precision medicine using synovial biopsy and RNA sequencing have identified molecular endotypes predicting differential treatment response, establishing a framework that could be applied to RA-ILD. Emerging biomarkers including leukocyte telomere length, circulating proteomics, and lung-based systems biology show promise for identifying RA-ILD molecular heterogeneity and guiding treatment selection.
Progress in RA-ILD precision medicine requires multimodal approaches integrating molecular phenotyping with targeted therapeutic trials. Lessons from RA joint precision medicine suggest accessing the disease compartment directly through bronchoscopy may provide crucial information beyond peripheral biomarkers. Prospective biomarker-stratified trials are urgently needed to overcome clinical equipoise and improve outcomes for this challenging condition.
类风湿关节炎相关间质性肺病（RA - ILD）导致生存率低下，从诊断时起平均仅3至5年。尽管其具有临床影响，但循证治疗方法仍然有限，这使得关于最佳管理策略的临床决策面临紧迫的不确定性。本综述探讨了可能指导更有效、个性化治疗决策的新兴精准医学方法。
基于放射学模式的当前治疗范式缺乏实证验证，最近的证据表明放射学特征难以预测免疫调节反应。使用滑膜活检和RNA测序的RA关节精准医学进展已确定预测不同治疗反应的分子内型，建立了一个可应用于RA - ILD的框架。包括白细胞端粒长度、循环蛋白质组学和基于肺部的系统生物学在内的新兴生物标志物有望识别RA - ILD的分子异质性并指导治疗选择。
RA - ILD精准医学的进展需要将分子表型与靶向治疗试验相结合的多模式方法。RA关节精准医学的经验表明，通过支气管镜直接进入疾病部位可能提供外周生物标志物之外的关键信息。迫切需要进行前瞻性生物标志物分层试验，以克服临床平衡问题并改善这种具有挑战性疾病的治疗结果。
