mrjСовременная ревматологияModern Rheumatology Journal1996-70122310-158XIMA-PRESS, LLC10.14412/1996-7012-2014-4-48-53mrj-575Research ArticleОБЗОРЫREVIEWSК вопросу и н терстициального поражения легких при ревматоидном артритеInterstitial lung involvement in rheumatoid arthritisБестаевДавид ВладимировичBestaevDavid Vladimirovich

115522, Россия, Москва, Каширское шоссе, д. 34А

34A, Kashirskoe Shosse, Moscow Russia 115522

davidbestaev@rambler.ruБестаеваТ. Д.BestaevaT. D.

362019, Россия, Республика Северная Осетия-Алания, Владикавказ, ул. Пушкинская, 40

40, Pushkinskaya St., Vladikavkaz, Republic of North Ossetia-Alania, Russia 362019

davidbestaev@rambler.ruФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian FederationГБОУ ВПО «Северо-Осетинская государственная медицинская академия» Минздрава РоссииРоссияNorth-Ossetian State Medical Academy, Ministry of Health of RussiaRussian Federation201403122014844853Copyright © Бестаев Д.В., Бестаева Т.Д., 20142014Бестаев Д.В., Бестаева Т.Д.Bestaev D.V., Bestaeva T.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://mrj.ima-press.net/mrj/article/view/575

Ревматоидный артрит (РА) – системное аутоиммунное ревматическое заболевание неизвестной этиологии, для которого характерны хронический эрозивный артрит и внесуставные проявления. Поражение легких является одним из частых внесуставных проявлений РА и может проявляться патологией бронхиального дерева, ревматоидными узелками, синдромом Каплана, поражением плевры, интерстиция легких (интерстициальное поражение легких – ИПЛ). Использование компьютерной томографии высокого разрешения позволяет диагностировать ИПЛ при РА примерно в 70% случаев, хотя частота ИПЛ может быть ниже (от 4 до 30%) в зависимости от методов диагностики, критериев отбора больных. Существует несколько гистопатологических вариантов ИПЛ, дифференциальная диагностика которых может вызывать затруднения. Обычная интерстициальная пневмония (ОИП) и неспецифическая интерстициальная пневмония являются основными вариантами ИПЛ, ассоциированного с РА. ИПЛ с картиной ОИП имеет более тяжелое течение, чем ИПЛ с другими гистологическими вариантами. Картина ИПЛ может осложняться вероятным токсическим эффектом ряда базисных противовоспалительных препаратов (БПВП), применяемых для лечения РА, например метотрексата и лефлуномида, и генно-инженерных биологических препаратов (ГИБП) – ингибиторов фактора некроза опухоли (ФНО) α. Необходимо дальнейшее исследование патогенеза поражения легких при РА, роли синтетических БПВП и ГИБП в развитии ИПЛ. Присутствие такого внесуставного проявления, как ИПЛ, влияет на выбор терапевтической тактики у больных РА.

Актуальность изучения ИПЛ при РА не вызывает сомнений. В статье обсуждается современное состояние исследований в данной области.

Rheumatoid arthritis (RA) is a systemic autoimmune rheumatic disease of unknown etiology, characterized by chronic erosive arthritis and extraarticular manifestations. Pulmonary involvement is one of the common extraarticular manifestations of RA and may show itself as bronchial tree lesions, rheumatoid nodules, Caplan's syndrome, and lesions in the pleura or pulmonary interstitium (interstitial lung involvement (ILI)). High-resolution computed tomography allows the diagnosis of ILI in RA in nearly 70% of cases although the incidence of ILI may be lower (4 to 30%) depending on diagnostic methods and patient selection criteria. There are several histopathological types of ILI, the differential diagnosis of which can be troublesome. Usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia are major types of RA-associated ILI. UIP-pattern ILI has a more severe course than ILI with other histological patterns. The clinical presentation of ILI may be complicated by the likely toxic effect of a number of disease-modifying antirheumatic drugs (DMARDs) used to treat RA, such as methotrexate and leflunomide, and biological agents (BAs), tumor necrosis factor-α (TNF-α) inhibitors. The pathogenesis of pulmonary involvement in RA and the role of synthetic DMARDs and BAs in the development of ILI call for further investigations.

An extraarticular manifestation, such as ILI, affects the choice of treatment policy in patients with RA.

The relevance of a study of ILI is beyond question. The paper discusses the state-of-the-art of investigations in this area.

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The authors declare that there are no conflicts of interest present.