RHEUMATOID ARTHRITIS: Edited by Joshua F. BakerManagement issues in rheumatoid arthritis-associated interstitial lung diseaseEngland, Bryant R.a,b; Hershberger, Danielc Author Information aDivision of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center (UNMC) bVA Nebraska-Western Iowa Healthcare System cDivision of Pulmonary, Critical Care, Sleep, & Allergy, Department of Internal Medicine, UNMC, Omaha, Nebraska, USA Correspondence to Bryant R. England, MD, PhD, Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE 61898-6270, USA. Tel: +1 402 559 7288; fax: +1 402 559 6788; e-mail: [email protected] Current Opinion in Rheumatology: May 2020 - Volume 32 - Issue 3 - p 255-263 doi: 10.1097/BOR.0000000000000703 Buy Metrics Abstract Purpose of review Summarize recent evidence on the identification and management of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Recent findings Clinical and subclinical interstitial lung disease (ILD) are frequent extra-articular manifestations of rheumatoid arthritis (RA). Better means of identifying and treating RA-ILD are needed to improve the prognosis, with a median survival of only 3–7 years after diagnosis. Several serum biomarkers are currently being evaluated for their ability to detect RA-ILD. Thorough evaluation and multidisciplinary discussion remains the gold standard for establishing the diagnosis of RA-ILD. Management is challenging with most RA disease-modifying antirheumatic drugs (DMARDs) linked to pneumonitis. Methotrexate is typically avoided in clinically significant ILD, although alternative therapies including leflunomide and biologic DMARDs also carry risks in RA-ILD. Antifibrotics appear to slow the progression of ILD, and a large phase II trial exclusively in RA-ILD is underway. In addition, smoking cessation, pulmonary rehabilitation, oxygen therapy, managing comorbidities, and lung transplantation evaluation are vital to improving patient outcomes in RA-ILD. Summary With little high-quality evidence to guide the management of RA-ILD, multidisciplinary teams with expertise in RA-ILD are highly valuable for diagnosing and treating RA-ILD. Clinical and translational research in RA-ILD is needed to fill the many evidence gaps. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.