Current approaches to screening, monitoring and treatment of interstitial lung disease in rheumatoid arthritis: a literature review

Bombela V.O., Shapoval I.I., Kedyk I.O., Orlova I.V., Perebetyuk L.S., Shvets L.V. , Stanislavchuk M.A.

• Vinnytsia National Medical University named after M.I. Pirogov, Vinnytsia

Summary. Interstitial lung disease (ILD) in rheumatoid arthritis (RA) is one of the clinically significant extra-articular manifestations of the disease and is associated with impaired functional status, reduced quality of life and an increased risk of adverse prognosis. The aim of this review was to systematize current evidence on the epidemiology, risk factors, screening, monitoring, progression criteria and treatment of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). The review was conducted as a systematized analysis of scientific sources selected in accordance with the PRISMA 2020 approach. The search covered publications from 2021 to 2026 in PubMed/MEDLINE, Scopus, Web of Science Core Collection, Embase and Cochrane Library, as well as clinical guidelines of professional organizations. The summarized data showed that the prevalence of ILD in RA substantially depends on the method of detection: registry-based studies more often identify clinically manifest cases, whereas active use of high-resolution computed tomography (HRCT) allows the detection of subclinical forms. The main risk factors include older age, male sex, smoking, longer duration of rheumatoid arthritis, seropositivity for rheumatoid factor and anti-cyclic citrullinated peptide antibodies, high disease activity, reduced forced vital capacity (FVC), impaired diffusing capacity of the lungs for carbon monoxide (DLCO), and the presence of a usual interstitial pneumonia (UIP) pattern. Screening should be organized as a selective risk-oriented process using clinical assessment, auscultation, pulmonary function tests and HRCT. Monitoring should be based on the dynamics of symptoms, FVC and DLCO values, and radiological changes. Treatment should be phenotype-oriented: immunosuppressive and biological agents are considered in the immunoinflammatory phenotype, whereas antifibrotic therapy becomes particularly important in progressive fibrosing disease.