Treatment of Interstitial Lung Disease in Rheumatoid Arthritis

Clinical Scenario

This protocol addresses interstitial lung disease (ILD) arising in the setting of rheumatoid arthritis (RA) — a recognised extra-articular manifestation that requires integrated management of both the inflammatory joint disease and the pulmonary complication.

Condition — Rheumatoid Arthritis with ILD

In RA-ILD, the degree of arthritis activity and the severity or progression of the lung disease together drive treatment decisions. Immunosuppressive treatment is recommended in this population (conditional recommendation, very low certainty of evidence).

Treatment Approach — Overview

Management involves immunosuppressive therapy, with the specific strategy tailored to whether arthritis is active or well-controlled and to the behaviour of the ILD. In patients with progressive pulmonary fibrosis, antifibrotic therapy forms part of the approach.

Full regimen details — including agent selection, sequencing, and combination strategies — are in the complete protocol.

Treatment Goals

Stabilisation of lung function and extent of lung fibrosis
Improvement in dyspnoea

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1183/13993003.02533-2024

We suggest using immunosuppressive treatment in patients with RA-ILD (conditional recommendation, very low certainty of evidence).

We suggest using immunosuppressive treatment in RA-ILD as it resulted in stabilisation of lung function and extent of lung fibrosis, and improvement in dyspnoea, quality of life and arthritis, with an acceptable adverse event profile.

We suggest using nintedanib in any CTD-ILD patients with progressive pulmonary fibrosis (conditional recommendation, low certainty of evidence).

We suggest using pirfenidone in patients with RA-ILD and a UIP pattern (conditional recommendation, very low certainty of evidence).

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