Management of the rheumatoid arthritis patient with interstitial lung disease

The treatment of rheumatoid arthritis (RA) has undergone considerable changes over the last 15-20 years. With an expansion in the armamentarium of therapies available for RA, comes a wider choice in selecting the best treatment in terms of comparative safety in the presence of comorbidities. Clinicians frequently encounter patients with RA-associated interstitial lung disease with uncontrolled joint disease, and have to make decisions about the safest treatments in this context with the eventual goal of joint remission. In this chapter, available evidence is reviewed on the comparative pulmonary safety of non-biologic disease modifying anti-rheumatic drugs (nbDMARDS), biologic DMARDs, biosimilars and targeted synthetic DMARDs in RA-ILD. In addition, the potential role for additional immunosuppression in RA-ILD is reviewed as well as overarching recommendations proposed for patient assessment to guide treatment decisions and management.