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Current Rheumatology Reviews


ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Mini-Review Article

Pulmonary Manifestations of Rheumatoid Arthritis, Psoriatic Arthritis and Peripheral Spondyloarthritis: Prevalence, Diagnostic Approach and Treatment Options

Author(s): Daniel Dejcman, Dirk Skowasch, Carmen Pizarro, Andreas Krause, Daniel Thomas and Valentin Sebastian Schäfer*

Volume 17, Issue 1, 2021

Published on: 05 September, 2020

Page: [17 - 28] Pages: 12

DOI: 10.2174/1573397116666200905122757

Price: $65


Interstitial lung disease (ILD) is the most common form of pulmonary impairment in patients with rheumatoid arthritis (RA). However, patients with RA or other arthritic diseases such as psoriatic arthritis (PsA) or peripheral spondyloarthritis (pSpA) are at a higher risk of developing several other pulmonary diseases, such as chronic obstructive lung disease (COPD), compared to patients without arthritis. This review aims at summarizing the current knowledge on the prevalence of pulmonary diseases in the above-mentioned forms of arthritis, the challenges faced by prevalence studies in detecting pulmonary diseases in patients with arthritis, as well as possible treatment options. Dyspnea, cough or other pulmonary symptoms in arthritis patients should prompt gradual diagnostic procedures considering pulmonary manifestations as a major cluster of differential diagnosis. However, treatment options often lack solid evidence-based guidelines and referrals to specialized centers are often necessary.

Keywords: Rheumatoid arthritis, psoriatic arthritis, peripheral spondyloarthritis, pulmonary manifestation, extra-articular manifestation, interstitial lung disease.

Graphical Abstract
Kelly C, Iqbal K, Iman-Gutierrez L, Evans P, Manchegowda K. Lung involvement in inflammatory rheumatic diseases. Best Pract Res Clin Rheumatol 2016; 30: 870-8.
Baillet A, Gossec L, Carmona L, et al. Points to consider for reporting, screening for and preventing selected comorbidities in chronic inflammatory rheumatic diseases in daily practice: A EULAR initiative. Ann Rheum Dis 2016; 75(6): 965-73.
[] [PMID: 26984008]
Daïen CI, Tubery A, Beurai-Weber M, et al. Relevance and feasibility of a systematic screening of multimorbidities in patients with chronic inflammatory rheumatic diseases. Joint Bone Spine 2019; 86(1): 49-54.
[] [PMID: 29654949]
West S. Clinical overview of rheumatoid arthritis.Lung Dis Rheum Arthritis. Cham: Springer International Publishing 2018; pp. 1-18.
Kristen Demoruelle M, Olson AL, Solomon JJ. The epidemiology of rheumatoid arthritis-associated lung disease.Lung Dis Rheum Arthritis. Cham: Springer International Publishing 2018; pp. 45-58.
Johnson C. Recent advances in the pathogenesis, prediction, and management of rheumatoid arthritis-associated interstitial lung disease. Curr Opin Rheumatol 2017; 29(3): 254-59.
Jones KD. Lung histopathology in rheumatoid arthritis.Lung Dis Rheum Arthritis. Cham: Springer International Publishing 2018; pp. 93-108.
Doyle TJ, Dellaripa PF, Rosas IO. Risk factors and biomarkers of RA-ILD.Lung Dis Rheum Arthritis. Cham: Springer International Publishing 2018; pp. 59-72.
Juge PA, Lee JS, Ebstein E, et al. MUC5B promoter variant and rheumatoid arthritis with interstitial lung disease. N Engl J Med 2018; 379(23): 2209-19.
[] [PMID: 30345907]
Morisset J, Lee JS. Rheumatoid arthritis-associated interstitial lung disease.Lung Dis Rheum Arthritis. Cham: Springer International Publishing 2018; pp. 109-9.
Epler GR. Bronchiolitis obliterans organizing pneumonia, 25 years: A variety of causes, but what are the treatment options? Expert Rev Respir Med 2011; 353-61. Available from:
Baqir M, Ryu JH. The Non-ILD pulmonary manifestations of RA.Lung Dis Rheum Arthritis. Cham: Springer International Publishing 2018; pp. 163-73.
Sathi N, Chikura B, Kaushik VV, Wiswell R, Dawson JK. How common is methotrexate pneumonitis? A large prospective study investigates. Clin Rheumatol 2012; 31(1): 79-83.
[] [PMID: 21638023]
Jani M, Dixon WG, Matteson EL. Management of the rheumatoid arthritis patient with interstitial lung disease.Lung Dis Rheum Arthritis. Cham: Springer International Publishing 2018; pp. 121-61.
Fragoulis GE, Nikiphorou E, Larsen J, Korsten P, Conway R. Methotrexate-associated pneumonitis and rheumatoid arthritis-interstitial lung disease: Current concepts for the diagnosis and treatment. Front Med Frontiers Media SA 2019; 6: 238.
Koslow M, Young JR, Yi ES, Baqir M, Decker PA, Johnson GB, et al. Rheumatoid pulmonary nodules: Clinical and imaging features compared with malignancy. Eur Radiol Springer Verlag 2019; 29: 1684-92.
Baruch AC, Steinbronn K, Sobonya R. Pulmonary adenocarcinomas associated with rheumatoid nodules: A case report and review of the literature. Arch Pathol Lab Med 2005; 129(1): 104-6.
[PMID: 15628888]
Spina D, Ambrosio MR, Rocca BJ, Di Mari N, Onorati M, Luzzi L, et al. Rheumatoid nodule and combined pulmonary carcinoma: Topographic correlations; a case report and review of the literature. Histol Histopathol 2011; 26(3): 351-6.
Kristen Demoruelle M, Olson AL, Solomon JJ. The epidemiology of rheumatoid arthritis associated lung disease. Cham: Humana Press 2018; pp. 45-58.
Ma Y, Tong H, Zhang X, et al. Chronic obstructive pulmonary disease in rheumatoid arthritis: A systematic review and meta-analysis. Respir Res 2019; 20(1): 144.
[] [PMID: 31288799]
Feldman SR, Zhao Y, Shi L, Tran MH. Economic and comorbidity burden among patients with moderate to severe psoriasis. J Manag Care Spec Pharm 2015; 21(10): 874-88.
[] [PMID: 26402388]
Li X, Kong L, Li F, Chen C, Xu R, Wang H, et al. Association between psoriasis and chronic obstructive pulmonary disease: A systematic review and meta-analysis. In: Alekseyenko AV, Ed. PLoS One 2015.
Khraishi M, MacDonald D, Rampakakis E, Vaillancourt J, Sampalis JS. Prevalence of patient-reported comorbidities in early and established psoriatic arthritis cohorts Clin Rheumatol 2011; 30: 877-5.
Peluso R, Iervolino S, Vitiello M, Bruner V, Lupoli G, Di Minno MND. Extra articular manifestations in psoriatic arthritis patients Clin Rheumatol Springer London 2015; 34: 745-53.
Wanat KA, Schaffer A, Richardson V, VanVoorhees A, Rosenbach M. Sarcoidosis and psoriasis: A case series and review of the literature exploring co-incidence vs coincidence. JAMA Dermatol 2013; 149(7): 848-52.
[] [PMID: 23783749]
Nikolopoulou M, Katsenos S, Psathakis K, Rallis E, Sampaziotis D, Panagou P, et al. Extra articular manifestations in psoriatic arthritis patients. Clin Rheumatol 2006; 34: 745-53.
Kanathur N, Lee-Chiong T. Pulmonary manifestations of Ankylosing Spondylitis. Clin Chest Med 2010; 31: 547-54.
Rodrigues CEM, Vieira WP, Bortoluzzo AB, et al. Low prevalence of renal, cardiac, pulmonary, and neurological extra-articular clinical manifestations in spondyloarthritis: Analysis of the Brazilian Registry of Spondyloarthritis. Rev Bras Reumatol 2012; 52(3): 375-83.
[PMID: 22641592]
Scambler T, Holbrook J, Savic S, McDermott MF, Peckham D. Autoinflammatory disease in the lung. Immunology 2018; 154(4): 563-73.
O’Dwyer DN, Armstrong ME, Cooke G, Dodd JD, Veale DJ, Donnelly SC. Rheumatoid Arthritis (RA) associated interstitial lung disease (ILD). Eur J Intern Med 2013; 24(7): 597-603.
[] [PMID: 23916467]
Kanat F, Levendoglu F, Teke T. Radiological and functional assessment of pulmonary involvement in the rheumatoid arthritis patients. Rheumatol Int 2007; 27: 459-66.
Aubart F, Crestani B, Nicaise-Roland P, et al. High levels of anti-cyclic citrullinated peptide autoantibodies are associated with co-occurrence of pulmonary diseases with rheumatoid arthritis. J Rheumatol 2011; 38(6): 979-82.
[] [PMID: 21362759]
Wang T, Zheng X-J, Ji Y-L, Liang Z-A, Liang B-M. Tumour markers in rheumatoid arthritis associated interstitial lung disease. Clin Exp Rheumatol 34: 587-91.
Chen J, Doyle TJ, Liu Y, et al. Biomarkers of rheumatoid arthritis-associated interstitial lung disease. Arthritis Rheumatol 2015; 67(1): 28-38.
[] [PMID: 25302945]
Doyle TJ, Patel AS, Hatabu H, et al. Detection of rheumatoid arthritis-interstitial lung disease is enhanced by serum biomarkers. Am J Respir Crit Care Med 2015; 191(12): 1403-12.
[] [PMID: 25822095]
Wang T, Zheng XJ, Liang BM, Liang ZA. Clinical features of rheumatoid arthritis-associated interstitial lung disease. Sci Rep 2015; 5: 1-7.
Dawson JK, Fewins HE, Desmond J, Lynch MP, Graham DR. Predictors of progression of HRCT diagnosed fibrosing alveolitis in patients with rheumatoid arthritis. Ann Rheum Dis 2002; 61: 517-21.
Brown AW, Nathan SD. The value and application of the 6 Minute walk test in idiopathic pulmonary fibrosis. Ann Am Thorac Soc 2018; 15: 3-10.
Biederer J, Schnabel A, Muhle C, Gross WL, Heller M, Reuter M. Correlation between HRCT findings, pulmonary function tests and bronchoalveolar lavage cytology in interstitial lung disease associated with rheumatoid arthritis. Eur Radiol 2004; 14: 272-80.
Bilgici A, Ulusoy H, Kuru O, Çelenk C, Ünsal M, Danaci M. Pulmonary involvement in rheumatoid arthritis. Rheumatol Int 2005; 25(6): 429-35.
[] [PMID: 16133582]
Zrour SH, Touzi M, Bejia I, et al. Correlations between high-resolution computed tomography of the chest and clinical function in patients with rheumatoid arthritis. Prospective study in 75 patients. Joint Bone Spine 2005; 72(1): 41-7.
[] [PMID: 15681247]
Walsh S. Thoracic Imaging in Rheumatoid Arthritis.Lung Dis Rheum Arthritis. Cham: Springer International Publishing 2018; pp. 73-91.
Cogliati C, Antivalle M, Torzillo D, et al. Standard and pocket-size lung ultrasound devices can detect interstitial lung disease in rheumatoid arthritis patients. Rheumatology 2014; 53(8): 1497-503.
[] [PMID: 24692573]
Moazedi-Fuerst FC, Kielhauser SM, Scheidl S, et al. Ultrasound screening for interstitial lung disease in rheumatoid arthritis. Clin Exp Rheumatol 2014; 32(2): 199-203.
[PMID: 24642277]
Jani M, Hirani N, Matteson EL, Dixon WG. The safety of biologic therapies in RA-associated interstitial lung disease. Nat Rev Rheumatol 2014; 10(5): 284-94.
[] [PMID: 24366321]
Rojas-Serrano J, Herrera-Bringas D, Pérez-Román DI, Pérez-Dorame R, Mateos-Toledo H, Mejía M. Rheumatoid arthritis-related interstitial lung disease (RA-ILD): Methotrexate and the severity of lung disease are associated to prognosis. Clin Rheumatol 2017; 36(7): 1493-500.
[] [PMID: 28585060]
Flaherty KR, Wells AU, Cottin V, Devaraj A, Walsh SLF, Inoue Y, et al. Nintedanib in progressive fibrosing interstitial lung diseases. N Engl J Med 2019; 381: 1718-27.
Behr J, Neuser P, Prasse A, Kreuter M, Rabe K, Schade-Brittinger C, et al. Exploring efficacy and safety of oral Pirfenidone for progressive, non-IPF lung fibrosis (RELIEF) - a randomized, double-blind, placebo-controlled, parallel group, multi-center, phase II trial. BMC Pulm Med. BMC Pulm Med 2017; 17: 1-9.
Martinez FJ, De Andrade JA, Anstrom KJ, King TE, Raghu G. Randomized trial of acetylcysteine in idiopathic pulmonary fibrosis. N Engl J Med 2014; 370: 2093-101.
Demedts M, Behr J, Buhl R, Costabel U, Dekhuijzen R, Jansen HM, et al. High dose Acetylcysteine in Idiopathic Pulmonary Fibrosis. N Engl J Med 2005; 353: 2229-42.
Rogliani P, Calzetta L, Cavalli F, Matera MG, Cazzola M. Pirfenidone, nintedanib and N-acetylcysteine for the treatment of idiopathic pulmonary fibrosis: A systematic review and meta-analysis. Pulm Pharmacol Ther 2016; 40: 95-103.
Behr J, Bendstrup E, Crestani B, Günther A, Olschewski H, Sköld CM, et al. Safety and tolerability of acetylcysteine and pirfenidone combination therapy in idiopathic pulmonary fibrosis: A randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Respir Med 2016; 4: 445-53.
Krause A, Rubbert-Roth A. Lungenbeteiligung bei rheumatoider arthritis. Z Rheumatol 2019; 78(3): 228-35.
[] [PMID: 30887119]
Sharp C, McCabe M, Dodds N, Edey A, Mayers L, Adamali H, et al. Rituximab in autoimmune connective tissue disease-associated interstitial lung disease. In: United Kingdom: Rheumatol. 2016; 55: pp. (7)1318-24.
Fernández-Díaz C, Loricera J, Castañeda S, et al. Abatacept in patients with rheumatoid arthritis and interstitial lung disease: A national multicenter study of 63 patients. Semin Arthritis Rheum 2018; 48(1): 22-7.
[] [PMID: 29422324]
Kawashiri S, Kawakami A, Sakamoto N, Ishimatsu Y, Eguchi K. A fatal case of acute exacerbation of interstitial lung disease in a patient with rheumatoid arthritis during treatment with tocilizumab. Rheumatol Int 2012; 32: 4023-6.
Gouveia PA, Ferreira ECG, Cavalcante Neto PM. Organizing pneumonia induced by tocilizumab in a patient with rheumatoid arthritis. Cureus, Inc 2020; 12(2): e6982.
Akiyama M, Kaneko Y, Yamaoka K, Kondo H, Takeuchi T. Association of disease activity with acute exacerbation of interstitial lung disease during tocilizumab treatment in patients with rheumatoid arthritis: a retrospective, case–control study Rheumatol Int 2016; 36: 881-9.
Manfredi A, Cassone G, Furini F, Gremese E, Venerito V, Atzeni F, et al. Tocilizumab therapy in rheumatoid arthritis with interstitial lung disease: A multicenter retrospective study. Intern Med J 2019; 50(9): 1085-90.
Mena-vázquez N, Godoy-navarrete FJ, Manrique-arija S, Aguilar-hurtado MC, Romero-barco CM, Ureña-garnica I, et al. Non-anti-TNF biologic agents are associated with slower worsening of interstitial lung disease secondary to rheumatoid arthritis. 2020.
Iqbal K, Kelly C. Treatment of rheumatoid arthritis-associated interstitial lung disease: A perspective review. Ther Adv Musculoskelet Dis 2015; 7(6): 247-67.

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