Ревматоидный артрит и интерстициальные заболевания легких: современные подходы к терапии

Интерстициальное заболевание легких (ИЗЛ) является наиболее тяжелым внесуставным проявлением ревматоидного артрита (РА) и одной из наиболее частых причин смерти этих пациентов. Лечение ИЗЛ при РА до сих пор остается предметом дискуссий. В идеале оно должно быть направлено на контроль активности суставной патологии, предотвращение ИЗЛ или замедление прогрессирования поражения легких, в частности фиброзных изменений. Противоревматические препараты, модифицирующие течение РА, используются в повседневной практике, но их эффективность при ИЗЛ не доказана, хотя хороший контроль системного заболевания может улучшить прогноз для пациентов. Иммунодепрессанты, обычно рекомендуемые для лечения ИЗЛ, связанного с иммуновоспалительным ревматическим заболеванием, часто обладают низкой эффективностью в отношении РА. Поэтому с целью определения оптимальной терапевтической стратегии для конкретного пациента обычно требуется междисциплинарное обсуждение, включающее как минимум ревматолога и пульмонолога. В данной статье будут рассмотрены доступные в настоящее время варианты лечения РА-ИЗЛ с акцентом на их возможное применение в соответствии с современными знаниями о патогенезе и клиническом развитии этого заболевания.

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