Diagnosis and problems in therapy of interstitial lung disease associated with rheumatoid arthritis


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Abstract

Rheumatoid arthritis (RA) is an inflammatory rheumatic disease of unknown etiology, which is characterized by symmetric, chronic, and erosive arthritis (synovitis) of the peripheral joints and systemic inflammatory involvement of the viscera. Lung pathology, including interstitial lung disease (ILD), is one of the common extra-articular manifestations in RA. ILD is considered to be present in almost 25% of the RA patients. To study a prognosis in RA patients with ILD was the objective of some investigations in the past decade, the majority of which concluded that the mean survival after the diagnosis was about 3 years. These indicators may reflect the predominance of usual interstitial pneumonia (UIP) in patients in specific trials as this type of lung disease is associated with a poorer prognosis. In addition, there are discrepant results on survival differences between RA patients with ILD and those with idiopathic ILD. However, the data were limited by a small number of cases in both medical centers and daily clinical practice. ILD is the only extra-articular manifestation of RA, the rate of which is increasing. ILD is considered to be a cause of death in nearly 6% of all the patients with RA. The pattern of ILD may be determined by high-resolution computed tomography and may be a major prognostic marker; the development of UIP is worst. The material is dedicated to the successes recently achieved in the diagnosis and therapy of RA-associated ILD. The state-of-the-art of investigations in this area is discussed.

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Диагностика и вопросы терапии интерстициального поражения легких, ассоциированного с ревматоидным артритом. - Аннотация. Ревматоидный артрит (РА) - воспалительное ревматическое заболевание неизвестной этиологии, характеризующееся симметричным хроническим эрозивным артритом (синовитом) периферических суставов и системным воспалительным поражением внутренних органов. Одним из частых внесуставных проявлений при РА служит патология легких, в частности интерстициальное поражение легких (ИПЛ). Считается, что ИПЛ имеется почти у 25% больных РА. Изучение прогноза у больных РА с ИПЛ явилось предметом нескольких исследований в прошлом десятилетии, в большинстве из которых был сделан вывод, что средняя продолжительность жизни с момента установления диагноза составляет около 3 лет. Возможно, данные показатели отражают преобладание обычной интерстициальной пневмонии (ОИП) у больных в конкретных исследованиях, так как данная форма поражения легких ассоциируется с более неблагоприятным прогнозом. Кроме того, существуют противоречивые результаты относительно различий по выживаемости между больными РА с ИПЛ и больными с идиопатическим ИПЛ. Однако данные ограничены небольшим количеством наблюдений как в медицинских центрах, так и в повседневной клинической практике. ИПЛ - единственное внесуставное проявление РА, частота которого увеличивается. Считается, что ИПЛ служит причиной смерти примерно 6% всех больных РА. Характер ИПЛ может быть определен при помощи компьютерной томографии высокого разрешения и представляется основным прогностическим маркером; при этом наиболее неблагоприятным является развитие ОИП. Материал посвящен успехам, достигнутым в последние годы в диагностике и терапии ИПЛ, ассоциированного с РА. Обсуждается современное состояние исследований в данной области.
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