The interpretation challenge is especially hard for RA-ILD, given its wide range of types and disease patterns. “There’s the usual interstitial pneumonia, there’s non-specific interstitial pneumonia, there are disease trajectories that tend to stay pretty stable, there are some that slowly progress over time, and there are a few unlucky ones that rapidly progress,” Dr. England says. Compounding the difficulty, ILD can occur roughly 7 to 10 years into the course of RA, with intervening drug interventions and comorbidities adding further variability to the mix.
From prior observational studies, doctors have at least learned a few key lessons, such as the importance of controlling RA from the start.3 “If we get good control of rheumatoid arthritis and lower their disease activity, similar to what we learned with cardiovascular disease years ago, that seems to be the thing that can help prevent interstitial lung disease,” Dr. England says.
To hone the preventive strategy, a prospective RA-ILD study that takes disease patterns, trajectories, biomolecular signatures, and other factors into account could help determine whether rheumatologists can more precisely select the right therapy for the right person. Although that precision medicine goal may be years away, Dr. England’s study suggests that in the meantime, TNF inhibitors shouldn’t be scrapped from the roster of potential interventions.
“It doesn’t mean that’s the perfect choice for everyone. It doesn’t mean that we can tell a patient, we know that this medicine is going to improve their lungs because we don’t,” he says. “But it still remains that for many people, these can still be effective medicines that will help control their rheumatoid arthritis, and we don’t have strong evidence that it’s going to cause them harm in their lungs.”
Bryn Nelson, PhD, is a medical journalist based in Seattle.
References
- Kadura S, Raghu G. Rheumatoid arthritis-interstitial lung disease: Manifestations and current concepts in pathogenesis and management. Eur Respir Rev. 2021 Jun 23;30(160):210011.
- England BR, Baker JF, George MD, et al. Advanced therapies in US veterans with rheumatoid arthritis-associated interstitial lung disease: A retrospective, active-comparator, new-user, cohort study. Lancet Rheumatol. 2025 Mar;7(3):e166–e177.
- Huang S, Kronzer VL, Dellaripa PF, et al. Rheumatoid arthritis-associated interstitial lung disease: Current update on prevalence, risk factors, and pharmacologic treatment. Curr Treatm Opt Rheumatol. 2020 Dec;6(4):337–353.
