Abstract

*Hamza Toufik, Majjad Abderrahim, Mohamed Ahmed Ghassem, Najlae El Ouardi, Julien H. Djossou, Aziza Mounach and Lahsen Achemlal

ABSTRACT

Rheumatoid arthritis (RA) is a systemic autoimmune disease affecting 0.5–1% of the worldwide population. Interstitial lung disease (ILD) is the most common respiratory manifestation of RA. It significantly affects the prognosis and limited treatment options for RA. With the current state of evidence, most treatments of RA are associated with a risk of onset or exacerbation of ILD, but with very different prevalence. However, methotrexate is associated with a risk of hypersensitivity pneumonitis, its link with a chronic ILD are unlikely. Cyclosporine appears effective and tolerated in ILD associated to other connective tissue diseases. Regarding biologic agents, rituximab remains relatively the best tolerated drug. Moreover, it is difficult to differentiate drug-induced toxicity from ILD related to rheumatoid arthritis or infections. In practice, the occurrence of ILD in RA requires an etiologic screening and pulmonary function tests. The decision to start cDMARDs or a biologic agent in patients at risk for ILD should be based only on its potential for improvement, especially in the absence of an alternative drug, with close monitoring and an extensive explanation to the patient.