Revista Colombiana de Reumatología (English Edition)最新文献

Interstitial lung disease (ILD) is a common and serious manifestation of autoimmune rheumatic diseases. While the prevalence of ILD differs among the individual autoimmune rheumatic diseases, ILD remains an important cause of morbidity and mortality in systemic sclerosis, systemic lupus erythematosus, mixed connective tissue disease, primary Sjögren's disease, rheumatoid arthritis, and idiopathic inflammatory myositis. The present review summarizes recent literature on autoimmune-associated ILD with a focus on screening and monitoring for ILD progression. Reflecting on the currently available evidence, the authors propose a guideline for monitoring for progression in patients with newly diagnosed autoimmune-associated ILD. This review also highlights clinical and biological predictors of progressive pulmonary fibrosis and describes opportunity for further study in the rapidly evolving area of rheumatology and pulmonology.

Rheumatoid arthritis associated interstitial lung disease (RA-ILD) has significant clinical impact on patients due to increased morbidity and mortality. Understanding the progression of ILD in patients with RA from when asymptomatic to clinical progression and the clinical, genetic, and novel markers associated with disease progression is an important step in altering the natural history of ILD in patients with RA. We review the natural history and epidemiology of RA-ILD, with a focus on Latin-American epidemiology in RA-ILD. Additionally, we discuss unique features of RA-ILD compared to other forms of ILD, early disease detection, and current concepts in treatment.

Autoimmune diseases comprise a wide and diverse group of diseases, each with its own specific complications, and with common complications such as pulmonary involvement. Lung involvement is extensive and one of its complications is interstitial lung disease, which varies widely within each of the autoimmune diseases. Health-related quality of life is defined as all those aspects that reflect the impact of the disease and the perception of disability and daily functionality of the patient. Even though this concept is subjective, health researchers have sought to define it to serve as a tool in the evaluation of interventions in subjects with different types of pathologies, so much so that it has become a main outcome in program evaluation and clinical research. To date, we are not aware of tools designed with the objective of measuring quality of life specifically in lung involvement due to interstitial lung disease related to autoimmune diseases. The objective of this review will be to further explore the available information on the measurement of quality of life in these patients.

Introduction/Objective

The aim of this study was to investigate the frequency of fibromyalgia (FM) in axial spondyloarthritis (ax-SpA) patients using the current FM diagnostic criteria (2016 Revised Fibromyalgia Diagnostic Criteria). Additionally, we aimed to investigate the relationship between FM severity and disease activity, functional status, and quality of life (QoL).

Materials and methods

Disease activity, functional disability and QoL were evaluated. FM severity was measured with the fibromyalgia impact questionnaire (FIQ).

Results

One hundred and three patients with ax-SpA (55.3% female; mean age 44 ± 10.85 years) were included. FM was detected in 49.5% of the patients. While FM was detected in 71% of patients with a history of peripheral arthritis, FM was present in 59.2% of patients without (p = 0.009). FM-ax-SpA patients showed higher disease activity except for C-reactive protein; functional status and QoL were statistically worse in patients with FM-SpA. Significant positive correlations were found between FIQ and disease activity, functional disability and QoL (p < .001).

Conclusions

The most effective features associated with the presence of FM were detected as gender and a history of peripheral arthritis. Presence of FM may cause an overestimation of disease activity, FM severity correlates with disease activity.

Interstitial lung disease is a common complication of Sjögren's syndrome that can occur at diagnosis or during follow-up. To detect it, complete pulmonary function studies should be performed, including spirometry, measurement of lung volumes, and DLCO, with the latter being the most sensitive parameter for detecting the presence of the disease. High-resolution computed tomography is essential for the study. Sixty percent of patients present a single tomographic pattern, with non-specific interstitial pneumonia being the most frequent pattern, followed by usual interstitial pneumonia pattern. Mortality is high, being higher in those with lower forced vital capacity, lower DLCO, and higher fibrosis score on chest computed tomography. Currently, there are two international guidelines for the treatment of pulmonary manifestations of Sjögren, but recommendations are based on low-quality scientific evidence. A stepwise approach is suggested, initially with glucocorticoids, then immunosuppressants, and in refractory or severe cases, considering other agents such as rituximab. The use of antifibrotic medication is recommended in patients who develop progressive pulmonary fibrosis as defined by current criteria. It is important to bear in mind that although non-specific interstitial pneumonia is considered a pattern where inflammation predominates, there may be progression to progressive pulmonary fibrosis in some cases. Lung transplantation and oxygen therapy may be options for selected patients. The relevance of an interdisciplinary team approach to achieve adequate diagnosis and treatment of patients is highlighted.

Introduction

Connective tissue disease-related interstitial lung disease (CTD-ILD) accounts for 30% of all cases of ILD. Some patients progress and develop progressive pulmonary fibrosis, which has a prognosis comparable to interstitial pulmonary fibrosis. In this study, relevant evidence about epidemiology, risk factors, biomarkers, and treatment are reviewed.

Materials and methods

A systematic review of the literature was carried out. Original observational and descriptive articles were included. Articles not providing information about the CTD diagnosis were excluded. PUBMED, EMBASE, SCOPUS, and LILACS were all searched. The total number of articles obtained was 528; data were extracted from 61 original articles.

Results

On average, ILD in these patients progressed by 33.7% over time. Patients with progressive pulmonary fibrosis had a similar 3.7-year median survival as those with idiopathic pulmonary fibrosis. Mortality was markedly increased (hazards ratio 3.29; 95% CI 2.76–3.82). A progressive course was seen in 34% of scleroderma (SSc) related ILD cases. Six interferon-induced proteins and a proteomic profile of 12 biomarkers were used to predict progression and response to treatment. The INBUILD and SENSCIS studies that assessed the effectiveness of nintedanib effectiveness revealed a reduced decrease in forced vital capacity. Progression in rheumatoid arthritis (RA) related ILD ranges from 38% to 50%. Control of RA disease activity and use of antifibrotics benefit the lungs.

Conclusion

A significant proportion of patients with CTD-ILD have progressive lung disease, with the corresponding adverse mortality effects. The majority of the data regarding CTD-ILD are from cohorts of patients with RA-ILD and SSc-ILD, in which antifibrotics and concurrent immunosuppressive treatments have been effective. There is not enough information available on other autoimmune disorders to draw any firm conclusions regarding progression rates or treatment effects.

Introduction/Objective

To review the epidemiology, general clinical aspects and diagnosis, impact on morbidity and mortality, and general treatment approaches for myositis-associated ILD.

Materials and methods

The relevant literature was reviewed.

Results

The clinical, radiographic, and histopathological features of interstitial lung disease (ILD) in idiopathic inflammatory myopathies (IIM) are similar to idiopathic ILD. Patients with a known diagnosis of myositis require prompt clinical evaluation including the determination of myositis-associated autoantibodies. Patients possessing autoantibodies associated with ILD or those with any pulmonary symptoms should undergo a pulmonary function test and high-resolution CT (HRCT) scanning of their lungs.

Conclusion

Despite the lack of placebo-controlled trials, systemic glucocorticoids are considered the mainstay of initial treatment of myositis-associated ILD. Glucocorticoid-sparing agents are often concomitantly administered, particularly in patients with severe disease. The first-line conventional immunosuppressive drugs include either mycophenolate mofetil or azathioprine. If these agents fail or if the pulmonary features are severe or rapidly progressive, then more aggressive immunosuppressive or immunomodulatory therapy including cyclophosphamide, tacrolimus or cyclosporine, rituximab, IVIg, or tofacitinib can be considered. Further investigations are required to assess the role of novel therapies in the treatment of myositis-associated ILD.

Interstitial lung disease (ILD) is a leading cause of both morbidity and mortality in systemic sclerosis (SSc). Radiographic lung abnormalities on high-resolution computed tomography (HRCT) imaging may be identified in 75–90% of those with SSc, while clinically significant ILD occurs in up to 40%. Early detection is important as early treatment in those with progressive ILD may improve outcomes. Appropriately risk-stratifying systemic sclerosis-associated ILD (SSc-ILD) is important in identifying those at highest risk of progression. This article summarises recent advances in SSc-ILD, particularly recommendations for screening, defining disease progression and monitoring.

This article will mention the essential aspects of managing ILD associated with systemic autoimmune diseases such as rheumatoid arthritis (RA) and inflammatory myopathies (IIM). The prognosis of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) has recently improved because of tighter control of RA disease activity. This article presents recent evidence of the effect of methotrexate on RA-ILD, which is associated with a better prognosis. The available alternatives include the use of anti-fibrotic drugs. In managing interstitial lung disease related to anti-synthetase syndrome (ASSD-ILD) and anti-MDA5-associated ILD, immunosuppression and anti-fibrotic drug regimens are relevant aspects mentioned.