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Progressive RA-ILD — SCE Rheumatology MCQ

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HardRheumatoid ArthritisProgressive RA-ILDSCE Rheumatology

A 45-year-old woman with RA develops progressive exertional dyspnoea. She has been on Methotrexate for 10 years. HRCT shows honeycombing and traction bronchiectasis at the bases consistent with UIP pattern. PFTs show FVC 58% and DLCO 42%. What is the recommended management for progressive RA-ILD with UIP pattern?

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Correct answer: C — Consider antifibrotic therapy (Nintedanib) through ILD-MDT discussion

Progressive fibrosing RA-ILD with UIP pattern may benefit from antifibrotic therapy. Nintedanib is approved for progressive fibrosing ILD including RA-ILD based on the INBUILD trial. The decision should be made through ILD-MDT discussion. Nintedanib slows FVC decline. Immunosuppression may also be considered (Mycophenolate Rituximab) depending on the degree of inflammation vs fibrosis. RA-ILD with UIP carries a worse prognosis than NSIP pattern. BSR guidance recommends multidisciplinary management of RA-ILD.

Reference: Kelly CA et al 2014 BSR RA-ILD; Flaherty KR et al 2019 INBUILD trial