Exploring Antifibrotic Strategies for Interstitial Lung Disease in Rheumatoid Arthritis: A Narrative Review

Narjes Sadat Farizani Gohari,1 Farahnaz Hoseinzadeh,2 Amirmohammad Khalaji,3 Samaneh Mirzaei,4,5 Mohsen Gholinataj jelodar6,7 1International Campus, Shahid Sadoughi University of Medical Science, Yazd, Iran; 2Pharmaceutical Sciences Research Center, School of Pharmacy, Student Research Committee, Shahid Sadoughi, University of Medical Sciences and Health Services, Yazd, Iran; 3School of Medicine, Tehran University of Medical Science, Tehran, Iran; 4Department of Health in Disaster and Emergencies, School of Public Health, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran; 5Trauma Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; 6Clinical Research Development Center, Shahid Rahnemoon Hospital, School of Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran; 7Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, IranCorrespondence: Mohsen Gholinataj jelodar, Division of pulmonary and Critical Care Medicine, Department of Internal Medicine, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran, Tel +989113143911, Email [email protected]: Rheumatoid arthritis (RA) is an autoimmune disease that primarily affects the joints, although extra-articular involvement, including interstitial lung disease (ILD), is also seen. Usual interstitial pneumonia and nonspecific interstitial pneumonia (NSIP) are the most common ILD in RA, which may be associated with the development of fibrotic changes in the lungs and a poorer prognosis for patients. However, the precise mechanism of ILD in RA remains unclear. A combination of environmental triggers, genetic predisposition, and enhanced immune system activity contributes to the formation of a chronic inflammatory process in the lungs, leading to uncontrolled fibroblast activity, which is ultimately associated with progressive fibrosis. Although currently available treatments for RA are effective for joint involvement, the efficacy of these anti-inflammatory treatments in progressive pulmonary fibrosis has not been encouraging. In recent years, the use of antifibrotic agents, which have been well-tested in the treatment of idiopathic pulmonary fibrosis (IPF), has been tested in the treatment of fibrotic and interstitial lung involvement in other diseases. In this study, we compared the pulmonary fibrotic developmental process of RA with IPF. Given the similarities in the pathogenesis and inflammatory pathways of these two entities, the use of antifibrotic drugs may offer a suitable and potentially promising strategy for treating fibrotic changes in RA. Currently, we face the challenge of a lack of sufficient studies with an appropriate sample size in this area. Therefore, the design and implementation of appropriate trials in the future should be considered a policy.Keywords: rheumatoid arthritis, antifibrotic, interstitial lung disease