The effect of disease modifying drugs on the lung in patients with rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is a systemic inflammatory disease mainly affecting the joints. It has extra-articular manifestations, including lung disease, a major contributor to morbidity and mortality. Careful assessment of systemic signs and symptoms of patients presenting to a pulmonologist with unexplained respiratory symptoms is very important, since RA itself can present with initial pulmonary symptoms without articular manifestations. Several disease modifying agents and biologics have been introduced to treat RA and have been shown to improve the quality of life and slow down the disease progression itself. The possibility of pulmonary toxicity with these drugs has been raised but establishing a causal relationship is difficult. In some case reports stopping the drug in question has reversed radiological changes and decreased inflammatory markers and symptoms, suggesting drug-related toxicity. However, some experts suggest that evolving or increasing pulmonary toxicity usually represents failure of treatment and an indication to switch to a different biologic or disease modifying agent. In this review we evaluate the association between methotrexate, leflunomide, and newer biologic agents and lung disease in patients with rheumatoid arthritis.

Key words: rheumatoid arthritis, interstitial lung disease, DMARDS, biological drugs