Promising Treatment for People with Arthritis and Lung Disease

Interstitial lung disease (ILD) is a relatively common complication for people with rheumatoid arthritis (RA). Taking many forms, ILD causes inflammation and scarring in the lungs and can lead to premature death in up to 10% of patients with RA, according to pulmonologist Joshua Solomon, MD. And with approximately 1.5 million Americans affected by RA, finding an effective treatment for this type of ILD is crucial.

The connection between RA and ILD is not yet fully understood. However, the joint inflammation caused by RA can affect different parts of the body. As the lungs become more inflamed, they can develop the scar tissue associated with ILD. This scar tissue isn’t as elastic as normal healthy tissue, making it harder for your lungs to expand and contract during breathing. As a result, people with ILD often find themselves exhausted by activities they used to perform effortlessly. They may experience discomfort in the chest, along with a dry hacking cough.

When patients have RA, their ILD can often go undiagnosed. "They already feel sick because of their RA," explained Dr. Solomon, who serves as the director of the Interstitial Lung Disease Center at National Jewish Health. "They've got joint disease. Sometimes they're not as active, so they don't know they're breathless. And if they are, sometimes it's attributed to other things. So this RA-ILD is under-diagnosed. That has a huge impact on patients. But the more we look for it, the more we find it. So we're working together to develop new screening guidelines."

While there are many drugs available for RA, options for interstitial lung disease with rheumatoid arthritis are scarce. However, Dr. Solomon has made addressing this disease a top priority. Working together with colleagues around the world, last year he was lead author on a study that showed for the first time how a class of anti-fibrotic drugs could slow the progression of ILD in patients with RA.

In the study, published in The Lancet Respiratory Medicine, Dr. Solomon and his research colleagues found that pirfenidone, an anti-scarring medication, was a safe and effective treatment option in a trial of patients with RA and ILD. "This research is a big step forward for patients suffering from interstitial lung disease with rheumatoid arthritis," said Dr. Solomon. "We showed that pirfenidone is safe and that it slows the progression of lung fibrosis over a year, giving hope that this treatment can have a positive impact on survival for these patients."

The treatment, which cut scarring progression by half, is a promising start toward finding a medication that can eventually be approved by the Food and Drug Administration (FDA). "This is just the beginning," said Dr. Solomon. "There are some exciting new drugs out there, and a few of those look like they could be home runs. But we really need to make sure these drugs are safe, because RA patients are on other medications for their joints."

After the breakthrough with pirfenidone, Dr. Solomon is confident that an FDA-approved medication for interstitial lung disease with rheumatoid arthritis is just 5-10 years away. "I think preliminary data on some of the agents that are being studied in phase three trials now are very promising. There's no reason to suspect they would not work in RA," Dr. Solomon said. "Soon, we're going to be able to stop the progression of fibrosis in these patients. We're not there yet, but it's coming."

To learn more about rheumatoid arthritis treatment at National Jewish Health, read about our Division of Rheumatology. You can also visit our ILD Program page here.