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Dtsch Med Wochenschr 2015; 140(12): 904-907
DOI: 10.1055/s-0041-102298
Klinischer Fortschritt
Rheumatologie
© Georg Thieme Verlag KG Stuttgart · New York

Rheumatoide Arthritis und Lunge: Mehr als nur ein Nebenschauplatz der Erkrankung

Rheumatoid arthritis and lung – more than a minor aspect of the disease
Christoph Fiehn
1   ACURA-Rheumazentrum Baden-Baden
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Publication History

Publication Date:
12 June 2015 (online)

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Zusammenfassung

Die Rheumatoide Arthritis (RA) manifestiert sich zwar vor allem als Polyarthritis, vieles spricht jedoch dafür, dass die Iniitiierung der pathophysiologisch entscheidenden Immunreaktion gegen citrullinierte Proteine in der Lunge stattfindet. Klinisch manifeste Mitbeteiligungen der Lunge bei der RA sind, trotz der wichtigen Rolle der Lunge in der Initiierung des autoimmunen Prozesses, mit 2–5 % der RA-Fälle insgesamt selten. Vor allem die fortgeschrittene interstitielle Lungenerkrankung (ILD) in Form der usual interstial pneumonia (UIP) ist jedoch prognostisch ungünstig und geht mit erhöhter Mortalität einher. Methotrexat (MTX), als wichtigstes DMARD zur Behandlung der RA, ist nicht mit dem Auftreten oder der Verschlechterung einer ILD assoziiert. Die MTX-induzierte Pneumonitis ist eine sehr seltene, wenn auch gravierende Toxizität dieser Therapie.

Abstract

Although rheumatoid arthritis (RA) mainly manifests as polyarthritis, there is growing evidence that the initiation of the pathological immune reaction against citrullinated peptides takes place in the lung. However, in spite of this important role of the lung in pathophysiology, clinically manifest lung involvement has been demonstrated only in about 2–5 % of the patients with RA, and therefore is relatively rare. In particular the severe interstitial lung involvement with histological pattern of usual interstitial pneumonia has a bad prognosis and an increased mortality. Methotrexate (MTX), as the most important disease modifying drug for treatment of RA is not associated with the appearance or progression of interstitial lung disease in RA. MTX-induced pneumonitis is a rare, although potentially severe complication of this treatment.

Schlüsselwörter

Rheumatoide Arthritis - citrullinierte Proteine - Lunge - Methotrexat-induzierte Pneumonitis

Keywords

rheumatoid arthritis - citrullinated peptide - lung - methotrexate-induced pneumonitis
 

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