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BioMed Research International
Volume 2013 (2013), Article ID 759760, 13 pages
http://dx.doi.org/10.1155/2013/759760
Review Article

The Multifaceted Aspects of Interstitial Lung Disease in Rheumatoid Arthritis

Division of Rheumatology, University and IRCCS Foundation Policlinico S. Matteo, Viale Golgi 3, 27100 Pavia, Italy

Received 21 May 2013; Revised 15 August 2013; Accepted 20 August 2013

Academic Editor: Carlo Jose Freire de Oliveira

Copyright © 2013 Lorenzo Cavagna et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Interstitial lung disease (ILD) is a relevant extra-articular manifestation of rheumatoid arthritis (RA) that may occur either in early stages or as a complication of long-standing disease. RA related ILD (RA-ILD) significantly influences the quoad vitam prognosis of these patients. Several histopathological patterns of RA-ILD have been described: usual interstitial pneumonia (UIP) is the most frequent one, followed by nonspecific interstitial pneumonia (NSIP); other patterns are less commonly observed. Several factors have been associated with an increased risk of developing RA-ILD. The genetic background plays a fundamental but not sufficient role; smoking is an independent predictor of ILD, and a correlation with the presence of rheumatoid factor and anti-cyclic citrullinated peptide antibodies has also been reported. Moreover, both exnovo occurrence and progression of ILD have been related to drug therapies that are commonly prescribed in RA, such as methotrexate, leflunomide, anti-TNF alpha agents, and rituximab. A greater understanding of the disease process is necessary in order to improve the therapeutic approach to ILD and RA itself and to reduce the burden of this severe extra-articular manifestation.