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RA-ILD — RACP Adult Medicine MCQ

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HardRheumatologyRA-ILDRACP Adult Medicine

A patient with rheumatoid arthritis has progressive fibrosing interstitial lung disease with a UIP pattern and meaningful FVC decline despite control of joint inflammation. What management approach is appropriate?

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Correct answer: A — Use joint rheumatology-respiratory ILD review to optimise rheumatoid therapy and consider antifibrotic treatment for progressive fibrosis

The best answer is “Use joint rheumatology-respiratory ILD review to optimise rheumatoid therapy and consider antifibrotic treatment for progressive fibrosis”. RA-associated UIP can progress despite controlled synovitis. Rheumatology-respiratory review integrates drug toxicity, immune therapy, pulmonary rehabilitation, oxygen and transplant assessment; nintedanib can slow decline in a progressive fibrosing phenotype. Reflex steroid escalation or withdrawal of all disease control is not evidence-based and creates substantial harm.

Reference: Australian Rheumatology Association: Rheumatoid arthritis: https://rheumatology.org.au/For-Patients/Adult-Medication-Information American College of Rheumatology: Treatment of interstitial lung disease in systemic autoimmune rheumatic diseases: https://rheumatology.org/interstitial-lung-disease-guideline