Abstract
Rheumatoid arthritis (RA) is a common chronic autoimmune disorder that characteristically
causes joint inflammation and damage. In addition, many patients develop extraarticular
manifestations which may cause significant comorbidity and premature mortality.
Some respiratory tract involvement of the upper and lower airways and parenchymal
disease features are unique to RA, including cricoarytenoid arthritis and RA pulmonary
nodulosis, and others, especially the interstitial parenchymal involvement, occur
in many other idiopathic and autoimmune diseases. The pathophysiology of lung disease
is not well understood. Rheumatoid lung disease may even predate the onset of joint
disease, and could be triggered by chronic airway and alveolar epithelial injury.
Chronic systemic inflammation and risk factors such as cigarette smoking, infection,
host genetics, and immune dysregulation are contributors. Treatment of the respiratory
disease is directed at reducing the systemic inflammation of RA. Less well understood
is the management of the interstitial lung disease of RA, for which antifibrotic and
immune suppressive agents may be helpful. The management of RA-related lung disease
is perhaps the major remaining hurdle in reduction of the disease burden related to
extraarticular manifestations of this disease.
Keywords
rheumatoid arthritis - airways disease - lung disease - interstitial lung disease
- pathology - diagnosis - treatment
