Revisão narrativa: pulmão e articulação, manifestações da artrite reumatoide no interstício pulmonar

Abstract

Rheumatoid Arthritis-associated Interstitial Lung Disease (RA-ILD) is one of the most severe extra-articular manifestations of Rheumatoid Arthritis (RA), with an alarming prevalence, evidenced by studies demonstrating changes consistent with ILD in up to 58% of RA patients undergoing pulmonary examinations. This condition has a significant impact on morbidity and mortality, with a mortality risk almost three times higher compared to those without lung disease. The etiology of RA-ILD is multifactorial, resulting from a complex interaction between genetic predisposition, environmental factors, and autoimmune dysregulation, with growing evidence that the lungs can act as an initial site for the development of autoimmunity. The diagnostic approach requires the collaboration of a multidisciplinary team, but faces the fundamental barrier of the absence of a universally accepted screening strategy, which delays early detection. Characterization of the predominant radiological pattern on HRCT is crucial, as it dictates the therapeutic strategy, which faces a central dilemma. Thus, DPI-AR represents a complex clinical challenge, highlighting the urgent need for randomized clinical trials and the identification of biomarkers that allow for early screening and risk stratification, enabling a precision medicine approach that is personalized and patient-centered to optimize outcomes and quality of life.