Interstitial lung disease
ICD-10 J84.9 · ICD-11 CB05

Treatment of ILD in Rheumatoid Arthritis When Immunosuppressive Therapy Has Not Stabilised Lung Function

Clinical Scenario

This protocol addresses rheumatoid arthritis-associated interstitial lung disease (RA-ILD) — a significant pulmonary complication of rheumatoid arthritis — in patients who require a next-line management approach after initial immunosuppressive treatment.

Why the Previous Treatment Was Insufficient

First-line immunosuppressive treatment was the established starting point for RA-ILD. This protocol applies when that initial therapy has failed to stabilise lung function, halt progression of lung fibrosis, or improve dyspnoea — the key treatment goals against which response is judged.

Next-Step Approach (partial)

The next-line strategy involves adjusting the immunosuppressant regimen — either by adding to or switching from the current therapy — depending on whether the patient is on single-agent or combination treatment. In cases where progressive pulmonary fibrosis is present, an additional agent from a different therapeutic class is incorporated.

Full regimen detail, agent selection criteria, and sequencing are in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

  • We suggest using immunosuppressive treatment in patients with RA-ILD (conditional recommendation, very low certainty of evidence).
  • If on mono or combination treatment, add or switch immunosuppressant.
  • If progressive pulmonary fibrosis, add nintedanib.
DOI: 10.1183/13993003.02533-2024
View source ↗