Tratamiento de la enfermedad pulmonar intersticial difusa asociada a la artritis reumatoide: ¿qué hay de nuevo desde las recomendaciones SER-SEPAR de 2022?

IF 1.3 Q4 RHEUMATOLOGY

Reumatologia Clinica Pub Date : 2026-04-01 Epub Date: 2026-02-21 DOI:10.1016/j.reuma.2026.502104

Javier Narváez , Petra Díaz del Campo Fontecha , M. Asunción Nieto , Virginia Villaverde García , Gloria Candelas Rodríguez , Alejandro Balsa

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引用次数: 0

Abstract

Objective

In 2020, the Spanish Society of Rheumatology (SER) and the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) published joint recommendations on the management of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Since then, new evidence has emerged supporting an update focused on treatment.

Methods

A systematic literature review was conducted covering the period from October 2020 to October 2025.

Results

IL-6 and JAK inhibitors (JAKi) show efficacy comparable to rituximab (RTX) and abatacept (ABA) in controlling joint disease, preserving pulmonary function, limiting radiological progression, and reducing RA-ILD-related mortality, without a significant increase in serious respiratory events. ABA has not demonstrated a lower risk of severe or opportunistic infections; therefore, these four options (ABA, RTX, anti-IL6, and JAKi) may be used interchangeably in RA-ILD patients requiring treatment intensification. In those with a progressive fibrosing phenotype and intolerance to nintedanib, pirfenidone may be considered.

Conclusions

Recent evidence has expanded the therapeutic options available for RA-ILD.

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与类风湿关节炎相关的弥漫性间质性肺病的治疗：自2022年SER-SEPAR建议以来，有什么新进展？

2020年，西班牙风湿病学会（SER）和西班牙肺科与胸外科学会（SEPAR）发布了关于类风湿关节炎相关间质性肺病（RA-ILD）治疗的联合建议。从那以后，出现了新的证据，支持对治疗的更新。方法对2020年10月~ 2025年10月的相关文献进行系统综述。结果sil -6和JAK抑制剂（JAKi）在控制关节疾病、保持肺功能、限制放射学进展和降低ra - ild相关死亡率方面的疗效与利妥昔单抗（RTX）和阿巴接受（ABA）相当，而严重呼吸事件的发生率没有显著增加。ABA没有显示出较低的严重感染或机会性感染风险；因此，这四种选择（ABA、RTX、anti-IL6和JAKi）可以在需要强化治疗的RA-ILD患者中互换使用。在进行性纤维化表型和对尼达尼布不耐受的患者中，可以考虑使用吡非尼酮。最近的证据扩大了RA-ILD的治疗选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Reumatologia Clinica RHEUMATOLOGY-

CiteScore

2.40

自引率

6.70%

发文量

105

审稿时长

54 days

期刊介绍： Una gran revista para cubrir eficazmente las necesidades de conocimientos en una patología de etiología, expresividad clínica y tratamiento tan amplios. Además es La Publicación Oficial de la Sociedad Española de Reumatología y del Colegio Mexicano de Reumatología y está incluida en los más prestigiosos índices de referencia en medicina.