Diagnostik und Therapie der Lungenbeteiligung bei rheumatoider Arthritis

Zusammenfassung

Die interstitielle Lungenerkrankung (ILD) ist eine der häufigsten extraartikulären Manifestationen der rheumatoiden Arthritis (RA) und betrifft 7–10% der RA-Patienten. Das frühzeitige Erkennen und Diagnosestellung sind entscheidend für den Verlauf. Das radiologische und histopathologische Bild reichen von nicht-spezifischer interstitieller Pneumonie (NSIP), organisierender Pneumonie (OP) bis zur usual interstitial pneumonia (UIP), die mit der ungünstigsten Prognose vergesellschaftet ist. Die Diagnostik basiert auf die Lungenfunktion, die hochauflösende Computertomographie (HR-CT) und ggf. die bronchoalveoläre Lavage. In der Behandlung der entzündlichen Formen ist die immunsuppressive Therapie mit Abatacept oder Rituximab den TNF-Blockern vorzuziehen. Bei progredientem Verlauf kommen antifibrotische Substanzen wie Nintedanib und Pirfenidon zum Einsatz. Die medikamentös-induzierte Pneumonitis, vor allem unter Methotrexat erfordert das sofortige Beenden der Behandlung und die Abgrenzung zur RA-ILD. Die Früherkennung, die individuelle Therapieanpassung und die multidisziplinäre Betreuung können dazu beitragen, die Prognose der Patienten mit RA-ILD zu verbessern.

Abstract

Interstitial lung disease (ILD) is one of the most common extra-articular manifestations of rheumatoid arthritis (RA), affecting approximately 7–10% of the RA patients. Early identification and diagnosis are crucial for the course of the disease. The radiological and histopathological spectrum ranges from non-specific interstitial pneumonia (NSIP), organizing pneumonia (OP) to usual interstitial pneumonia (UIP), which is associated with the poorest prognosis. Diagnostic evaluation is based on pulmonary function testing, high-resolution computed tomography (HRCT), and, if indicated, bronchoalveolar lavage. In inflammatory forms, immunosuppressive treatment with abatacept or rituximab is preferred to TNF inhibitors. In progressive cases, antifibrotic agents such as nintedanib and pirfenidone are used. Drug-induced pneumonitis, particularly associated with methotrexate, requires immediate discontinuation of the medication and must be differentiated from RA-associated ILD. Early detection, individualised therapeutic strategies, and multidisciplinary care are essential to improving prognosis of patients with RA-associated ILD.

Schlüsselwörter

rheumatoide Arthritis - interstitielle Lungenerkrankung - UIP - Behandlung - Nintedanib

Keywords

rheumatoid arthritis - interstitial lung disease - UIP - treatment - nintedanib

Publication History

Received: 02 August 2025

Accepted: 11 August 2025

Article published online:
08 October 2025

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