rheumatoid arthritis-associated interstitial lung disease diagnostic dilemma风湿性arthritis-associated间质性肺病诊断困境.pdfVIP

Hindawi Publishing Corporation Pulmonary Medicine Volume 2011, Article ID 872120, 12 pages doi:10.1155/2011/872120 Review Article Rheumatoid Arthritis-Associated Interstitial Lung Disease: Diagnostic Dilemma Mark J. Hamblin and Maureen R. Horton Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, 5th Floor, Baltimore, MD 21205, USA Correspondence should be addressed to Maureen R. Horton, mhorton2@ Received 21 October 2010; Revised 1 March 2011; Accepted 24 March 2011 Academic Editor: D. Bouros Copyright © 2011 M. J. Hamblin and M. R. Horton. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Interstitial lung disease (ILD) is an increasingly recognized complication of rheumatoid arthritis (RA) contributing to significantly increased morbidity and mortality. Diagnosis can be challenging since patients are unlikely to report dyspnea due to an overall decrease in physical activity with advanced arthritic symptoms. Additionally, infections, drug toxicity, and environmental toxins can mimic ILD, creating significant diagnostic dilemmas for the clinician. In this paper we will explore an effective clinical algorithm for the diagnosis of RA-ILD. We will also discuss features of drug-related toxicities, infections, and environmental toxins that comprise the main entities in the differential diagnosis of RA-ILD. Finally, we will explore the known and experimental treatment options that may have some benefit in the treatment of RA-ILD. 1. Introduction and treatment o