When we talk about rheumatoid arthritis we shouldn’t just think about joints, pain and physical disability. In Italy, in fact, more than 10% of patients with rheumatoid arthritis are also affected by interstitial lung disease, with over 30 thousand women and men living with a complication that negatively affects their life expectancy and quality. A serious health problem that must be managed in the care of patients with rheumatoid arthritis through the same process in all Regions. The definition of a truly operational diagnostic-therapeutic care pathway (or PTDA) across the entire national territory was requested by ANMAR (National Association of Rheumatic Patients). “The PTDA is indispensable and must be considered by the institutions as a tool that aims to contain the costs that weigh on the national health service – states Silvia Tonolo, National President of ANMAR -. Patients, on the other hand, need it to feel truly taken care of in the management of a particularly insidious complication. Throughout this process, the patient must be an active and integral part of the entire care process”.
What is pulmonary complication
Shortness of breath, chronic dry cough, weakness, tiredness, chest pain, loss of appetite and weight. These are the symptoms of interstitial lung disease, unfortunately non-specific and attributable to many other diseases. “This is why it is really difficult to obtain an early diagnosis”, continues Mauro Galeazzi, Scientific Director of the CAPIRE Observatory. “However, delays can have serious consequences since a third of complications can evolve into pulmonary fibrosis. In this case, irreversible organ damage and a general worsening of all respiratory symptoms result.” Furthermore, at a rheumatological level, interstitial disease not only affects rheumatoid arthritis but also patients affected by systemic lupus erythematosus, mixed connective tissue disease, Sjögren’s syndrome and systemic sclerosis.
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How to diagnose and treat
It is usually identified through a medical examination and a clinical chest exam. Not all patients require pharmacological treatment, the opportunity of which must be assessed considering various factors such as age, habits, other diseases and therapies taken. “In other cases it is instead advisable to agree with the patient on a treatment that can be based on immunosuppressants, anti-fibrotics or their combination. One of the major difficulties is that effective drugs against rheumatoid arthritis, such as biological ones , do not determine any clinical benefit on interstitial disease. For all these reasons, the definition of a PDTA could standardize all diagnostic-therapeutic interventions in our country. Furthermore, it would lead to significant advantages in terms of optimizing the use of all available resources”, adds Gian Domenico Sebastiani, President of the Italian Society of Rheumatology-SIR.
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Who is at risk
Rheumatoid arthritis is one of the most widespread and feared rheumatological diseases. In Italy there are a total of over 300 thousand cases and women are the most affected, in particular those of childbearing age, between 35 and 40 years old. It is a form of chronic autoimmune inflammatory arthritis that affects the joints of the hands, feet, wrists, ankles, knees, hip, elbow and shoulder. “It can also affect the lungs – underlines Alfredo Sebastiani, Director of the UOSD Day Hospital Pneumology and Interstitial Lung Diseases, San Camillo-Forlanini Hospital, Rome -. The patients to be considered most at risk of interstitial diseases are male, smokers or ex-smokers, aged over 60 years of age, have high levels of anti-citrulline and rheumatoid factor antibodies and have greater disease activity. Assistance and treatment are still complicated and should be entrusted to a multidisciplinary team made up of rheumatologists, pulmonologists and radiologists with experience sufficient number of rare diseases. Only in this way can we guarantee a good level of care and also the administration of the most up-to-date therapies which are currently managed by a few expert centers”.
“The start of a PDTA represents an urgent need for the rheumatological patient affected by interstitial lung disease – concludes Tonolo -. If correctly applied, it can be a fundamental means to improve diagnosis, treatment and follow up. As an Association we intend to raise awareness all the institutions on a topic, which we believe is underestimated, such as that of pulmonary complications in rheumatology. The final objective must be to arrive at a proactive patient who is a protagonist, capable of expressing what he feels and thus obtaining advantages for the entire community”.