Rheumatoid Arthritis-Associated Interstitial Lung Disease: Diagnostic Dilemma

Table 2

Common pulmonary drug toxicities and associated risk factors associated with medications used to treat rheumatoid arthritis.

Medication	Pulmonary toxicity	Risk factors
NSAIDS	Noncardiogenic pulmonary edema,	High-dose treatment
	Acute eosinophilic pneumonia,
	Interstitial pneumonitis
Gold salts	Interstitial pneumoitis, bronchiolitis obliterans with or without organizing pneumonia, pulmonary renal syndrome, diffuse alveolar damage	Unknown, possible genetic association and cumulative ingestion >500 mg gold
D-penicillamine	Bronchiolitis obliterans, pulmona renal syndrome, diffuse alveolar damage	Unknown
Methotrexate	Acute interstitial pneumonitis, pulmonary fibrosis, pleural thickening, and chronic cough	DLCO < 70% of predicted; tobacco abuse >25 pack years; hypoalbuminemia; prior use of DMARDs; RA pleuropulmonary involvement; advanced age; diabetes mellitus
Anti-TNF-α biologic agents	Interstitial pneumoitis, rapidly progressive pulmonary fibrosis	Possible prior RA-ILD
Leflunomide	Interstitial pneumonitis	Loading dose of leflunomide; pre-existing ground glass infiltrates on HRCT