Lunge – Interstitielle Lungenerkrankungen in der Rheumatologie

Zusammenfassung

Interstitielle Lungenerkrankungen (ILD) gehören zu den häufigsten Organmanifestationen bei entzündlich-rheumatischen Systemerkrankungen. Sie können sich bei einer Vielzahl rheumatischer Erkrankungen manifestieren, insbesondere bei rheumatoider Arthritis, systemischer Sklerose und idiopathischen inflammatorischen Myopathien. ILD sind mit einer erhöhten Morbidität und Mortalität assoziiert. Eine sorgfältige Diagnostik unter Einbeziehung von Klinik, apparativer und Labordiagnostik ist zur Klassifikation und Risikostratifizierung der zugrundeliegenden Erkrankung und vorliegenden Lungenbeteiligung unabdingbar. Auch wenn weiterhin nicht alle ätiologischen und pathogenetischen Details bekannt sind, haben die letzten Jahre einige Fortschritte in Verständnis und Management der (CTD-) ILD ergeben.

Abstract

Interstitial lung diseases (ILD) are one of the most frequent organ manifestations in rheumatic diseases and still challenging for diagnosis and management. ILD can be present in different types of rheumatic diseases, including rheumatoid arthritis, systemic sclerosis and idiopathic inflammatory myopathies (CTD-ILD). ILDs are associated with significant morbidity and mortality. A careful clinical instrumental and laboratory assessment is necessary. This allows precise classification of the different phenotypes of underlying inflammatory diseases and stratification of the risk of lung involvement and disease progression. There is still a lack of understanding of the underlying mechanisms, but there have been advances in the understanding and management of (CTD-) ILDs in recent years.

Schlüsselwörter

Interstitielle Lungenerkrankungen - Lungenfibrose - rheumatoide Arthritis - systemische Sklerose - idiopathische inflammatorische Myopathien

Key words

Interstitial lung diseases - pulmonary fibrosis - rheumatoid arthritis - systemic sclerosis - idiopathic inflammatory myopathies

Publikationsverlauf

Artikel online veröffentlicht:
23. September 2021

• Literatur

• 1 Fischer A, Lee JS, Cottin V. Interstitial Lung Disease Evaluation: Detecting Connective Tissue Disease. Respiration 2015; 90: 177-184
• 2 Fischer A, Strek ME, Cottin V. et al. Proceedings of the American College of Rheumatology/Association of Physicians of Great Britain and Ireland Connective Tissue Disease-Associated Interstitial Lung Disease Summit: A Multidisciplinary Approach to Address Challenges and Opportunities. Arthritis Rheumatol Hoboken NJ 2019; 71: 182-195
• 3 American Thoracic Society, European Respiratory Society. American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee, June 2001. Am J Respir Crit Care Med 2002; 165: 277-304
• 4 An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. – Abstract – Europe PMC. Im Internet https://europepmc.org/article/med/24032382
• 5 Cottin V, Hirani NA, Hotchkin DL. et al. Presentation, diagnosis and clinical course of the spectrum of progressive-fibrosing interstitial lung diseases. Eur Respir Rev Off J Eur Respir Soc 2018; 27: 180076
• 6 Duarte AC, Porter JC, Leandro MJ. The lung in a cohort of rheumatoid arthritis patients-an overview of different types of involvement and treatment. Rheumatol Oxf Engl 2019; 58: 2031-2038
• 7 Juge P-A, Lee JS, Ebstein E. et al. MUC5B Promoter Variant and Rheumatoid Arthritis with Interstitial Lung Disease. N Engl J Med 2018; 379: 2209-2219
• 8 Hyldgaard C, Hilberg O, Pedersen AB. et al. A population-based cohort study of rheumatoid arthritis-associated interstitial lung disease: comorbidity and mortality. Ann Rheum Dis 2017; 76: 1700-1706
• 9 Ito Y, Arita M, Kumagai S. et al. Radiological fibrosis score is strongly associated with worse survival in rheumatoid arthritis-related interstitial lung disease. Mod Rheumatol 2019; 29: 98-104
• 10 Adler S, Huscher D, Siegert E. et al. Systemic sclerosis associated interstitial lung disease – individualized immunosuppressive therapy and course of lung function: results of the EUSTAR group. Arthritis Res Ther 2018; 20: 17
• 11 Goh NS, Hoyles RK, Denton CP. et al. Short-Term Pulmonary Function Trends Are Predictive of Mortality in Interstitial Lung Disease Associated With Systemic Sclerosis. Arthritis Rheumatol Hoboken NJ 2017; 69: 1670-1678
• 12 Hoffmann-Vold A-M, Maher TM, Philpot EE. et al. The identification and management of interstitial lung disease in systemic sclerosis: evidence-based European consensus statements. Lancet Rheumatol 2020; 2: e71-e83
• 13 Distler O, Volkmann ER, Hoffmann-Vold AM. et al. Current and future perspectives on management of systemic sclerosis-associated interstitial lung disease. Expert Rev Clin Immunol 2019; 15: 1009-1017
• 14 Flament T, Bigot A, Chaigne B. et al. Pulmonary manifestations of Sjögren’s syndrome. Eur Respir Rev Off J Eur Respir Soc 2016; 25: 110-123
• 15 Bauhammer J, Fiehn C. Antisynthetasesyndrome. Z Für Rheumatol 2019; 78: 645-655
• 16 Barba T, Mainbourg S, Nasser M. et al. Lung Diseases in Inflammatory Myopathies. Semin Respir Crit Care Med 2019; 40: 255-270
• 17 Comarmond C, Crestani B, Tazi A. et al. Pulmonary Fibrosis in Antineutrophil Cytoplasmic Antibodies (ANCA)-Associated Vasculitis. Medicine (Baltimore) 2014; 93: 340-349
• 18 Cosgrove GP, Lasky JA. A New Piece to Help Solve the Interstitial Lung Disease Diagnostic Puzzle. Am J Respir Crit Care Med 2021; 203: 158-160
• 19 Raghu G, Flaherty KR, Lederer DJ. et al. Use of a molecular classifier to identify usual interstitial pneumonia in conventional transbronchial lung biopsy samples: a prospective validation study. Lancet Respir Med 2019; 7: 487-496
• 20 Lee JS, Lee EY, Ha Y-J. et al. Serum KL-6 levels reflect the severity of interstitial lung disease associated with connective tissue disease. Arthritis Res Ther 2019; 21: 58
• 21 Kreuter M, Ochmann U, Koschel D. et al. Patientenfragebogen zur Erfassung der Ursachen interstitieller und seltener Lungenerkrankungen – klinische Sektion der DGP. Pneumologie 2018; 72: 446-457
• 22 Fischer A, Antoniou KM, Brown KK. et al. An official European Respiratory Society/American Thoracic Society research statement: interstitial pneumonia with autoimmune features. Eur Respir J 2015; 46: 976-987
• 23 Tashkin DP, Elashoff R, Clements PJ. et al. Cyclophosphamide versus Placebo in Scleroderma Lung Disease. N Engl J Med 2006; 354: 2655-2666
• 24 Tashkin DP, Roth MD, Clements PJ. et al. Mycophenolate mofetil versus oral cyclophosphamide in scleroderma-related interstitial lung disease (SLS II): a randomised controlled, double-blind, parallel group trial. Lancet Respir Med 2016; 4: 708-719
• 25 A retrospective study on the predictive implications of clinical characteristics and therapeutic management in patients with rheumatoid arthritis-associated interstitial lung disease. springermedizin.de. Im Internet: https://www.springermedizin.de/a-retrospective-study-on-the-predictive-implications-of-clinical/17672666
• 26 Juge P-A, Lee JS, Lau J. et al. Methotrexate and rheumatoid arthritis associated interstitial lung disease. Eur Respir J 2021; 57: 2000337
• 27 Ibfelt EH, Jacobsen RK, Kopp TI. et al. Methotrexate and risk of interstitial lung disease and respiratory failure in rheumatoid arthritis: a nationwide population-based study. Rheumatol Oxf Engl 2021; 60: 346-352
• 28 Duarte AC, Cordeiro A, Fernandes BM. et al. Rituximab in connective tissue disease-associated interstitial lung disease. Clin Rheumatol 2019; 38: 2001-2009
• 29 Sircar G, Goswami RP, Sircar D. et al. Intravenous cyclophosphamide vs rituximab for the treatment of early diffuse scleroderma lung disease: open label, randomized, controlled trial. Rheumatol Oxf Engl 2018; 57: 2106-2113
• 30 Fernández-Díaz C, Loricera J, Castañeda S. et al. Abatacept in patients with rheumatoid arthritis and interstitial lung disease: A national multicenter study of 63 patients. Semin Arthritis Rheum 2018; 48: 22-27
• 31 Khanna D, Denton CP, Jahreis A. et al. Safety and efficacy of subcutaneous tocilizumab in adults with systemic sclerosis (faSScinate): a phase 2, randomised, controlled trial. Lancet Lond Engl 2016; 387: 2630-2640
• 32 Khanna D, Lin CJF, Furst DE. et al. Tocilizumab in systemic sclerosis: a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Respir Med 2020; 8: 963-974
• 33 Roofeh D, Lin CJF, Goldin J. et al. Tocilizumab Prevents Progression of Early Systemic Sclerosis-Associated Interstitial Lung Disease. Arthritis Rheumatol Hoboken NJ 2021;
• 34 Huang Y, Lin W, Chen Z. et al. Effect of tumor necrosis factor inhibitors on interstitial lung disease in rheumatoid arthritis: angel or demon? . Drug Des Devel Ther 2019; 13: 2111-2125
• 35 Kurasawa K, Arai S, Namiki Y. et al. Tofacitinib for refractory interstitial lung diseases in anti-melanoma differentiation-associated 5 gene antibody-positive dermatomyositis. Rheumatol Oxf Engl 2018; 57: 2114-2119
• 36 Chen Z, Wang X, Ye S. Tofacitinib in Amyopathic Dermatomyositis-Associated Interstitial Lung Disease. N Engl J Med 2019; 381: 291-293
• 37 Bejarano M, Tamborenea MN, Goñi MA. et al. AB0418 INTERSTITIAL LUNG DISEASE IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH TOFACITINIB. Ann Rheum Dis 2019; 78: 1672-1672
• 38 George PM, Spagnolo P, Kreuter M. et al. Progressive fibrosing interstitial lung disease: clinical uncertainties, consensus recommendations, and research priorities. Lancet Respir Med 2020; 8: 925-934
• 39 Highland KB, Distler O, Kuwana M. et al. Efficacy and safety of nintedanib in patients with systemic sclerosis-associated interstitial lung disease treated with mycophenolate: a subgroup analysis of the SENSCIS trial. Lancet Respir Med 2021; 9: 96-106
• 40 Distler O, Highland KB, Gahlemann M. et al. Nintedanib for Systemic Sclerosis–Associated Interstitial Lung Disease. N Engl J Med 2019;
• 41 Behr J, Prasse A, Kreuter M. et al. Pirfenidone in patients with progressive fibrotic interstitial lung diseases other than idiopathic pulmonary fibrosis (RELIEF): a double-blind, randomised, placebo-controlled, phase 2b trial. Lancet Respir Med 2021; 9: 476-486