Envolvimento Pulmonar em Artrite Reumatoide: uma revisão abrangente

• DOI: https://doi.org/10.22533/at.ed.65424141016

• Palavras-chave: Artrite reumatoide. Doença pulmonar intersticial. Fibrose pulmonar.

• Keywords: Rheumatoid arthritis. Interstitial lung disease. Pulmonary fibrosis.

• Abstract: Rheumatoid arthritis (RA) is a chronic inflammatory disease, characterized by pain and swelling in several joints. Despite the predominance of joint involvement, RA can affect various organs and systems such as the heart, the nervous system, the eyes, and the lungs, among others. Pulmonary involvement is an important cause of morbidity and mortality, and its manifestations may be varied, with different involvement ranging from interstitial infiltrates, bronchiectasis and bronchiolitis, pleural involvement, the presence of rheumatoid nodules in the lungs, vascular bed diseases, pulmonary toxicity due to the medication effect of drugs used in the treatment of the disease, and even secondary infectious processes. Interstitial lung disease (ILD) is the most prevalent manifestation, which may progress to pulmonary fibrosis and consequent respiratory failure, affecting the prognosis of the disease. This review elucidates the spectrum of pulmonary complications in RA, focusing primarily on interstitial lung disease (ILD), and analyses the efficacy of different treatment modalities. Our comprehensive review included various studies and reports evaluating the clinical presentations, diagnostic approaches, and treatment outcomes of patients with RA-related pulmonary diseases. We paid particular attention to radiological findings, particularly high-resolution computed tomography (HRCT), and assessed the impact of different pharmacological treatments. The findings revealed that pulmonary involvement in RA varies, ranging from asymptomatic patients to patients with severe ILD. Interstitial pneumonia has emerged as the most prevalent manifestation, affecting up to 60% of patients and, in some cases, preceding joint symptoms. The effectiveness of treatments varies, with specific disease-modifying anti-rheumatic drugs (DMARDs) showing potential for controlling pulmonary symptoms. However, the risk of medication-induced pulmonary toxicity is a notable concern. Early diagnosis and tailored treatment strategies are crucial for the effective management of RA-related pulmonary diseases.