Pathogenesis and treatment of idiopathic and rheumatoid arthritis-related interstitial pneumonia. The possible lesson from COVID-19 pneumonia

Abstract

Introduction: Main clinical manifestations of SARS-CoV-2 infection are characterized by fever, dyspnea, and interstitial pneumonia, frequently evolving in acute respiratory distress syndrome (ARDS).

Areas covered: Features of coronavirus disease 2019 (COVID-19) presents some common points with interstitial lung disease (ILD) both idiopathic and related to rheumatoid arthritis (RA), typically characterized by a chronic progression over time and possibly complicated by acute exacerbation (AE). The study of common pathogenetic mechanisms, such as the involvement of toll-like receptor 4, could contribute to the knowledge and treatment of idiopathic and RA-ILD. Moreover, hyperinflammation, mainly characterized by increase of effector T-cells and inflammatory cytokines, and activation of coagulation cascade, observed in COVID-19 related ARDS have been already shown in patients with AE of idiopathic and RA-ILD. A literature search was performed in PubMed, Embase, Scopus, and Web of Science, together with a manual search in COVID-resource centers of the main journals.

Expert opinion: Despite the uncertainty about pathogenetic aspects about COVID-19- pneumonia, it could be a possible model for other forms of ILD and AE. The great amount of data from studies on COVID-19 could be helpful in proposing safe therapeutic approaches for RA-ILD, in understanding pathogenesis of usual interstitial pneumonia and to develop new therapeutic strategies for AE.

Keywords: COVID-19; acute exacerbation; idiopathic pulmonary fibrosis; interstitial lung disease; rheumatoid arthritis; toll-like receptor.

Figure 1.

High-resolution lung base image from contrast-enhancement arterial scan for pulmonary embolism detection in patient with long-standing COVID-19 pneumonia and pneumomediastinum. Ground-glass opacities are detected in subpleural areas mixed with focal consolidations. Moreover, computed tomography shows initial fibrotic changes with architectural distortion and bronchiolectasis. Multiple thin-walled cysts are also recognized, in keeping with smoking-related changes (courtesy by Gabriele D’Andrea, Radiology Unit, San Gerardo Hospital, ASST Monza, Monza, Italy).

Figure 2.

Ground-glass areas in COVID-19 pneumonia (Figure 2a) in a patient with ankylosing spondylitis and preexisting fibrosing nonspecific interstitial pneumonia (Figure 2b).