Contemporary Guideline Perspectives on Methotrexate and Biologic/Targeted Synthetic Disease-Modifying Antirheumatic Drugs (DMARDs) in Rheumatoid Arthritis-Associated Interstitial Lung Disease
Abstract
Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is an extra-articular manifestation that affects the patient outcomes. Published guidelines and consensus documents on RA-ILD or systemic autoimmune rheumatic disease/connective tissue disease-associated ILD have updated drug selection for RA-ILD; however, their meanings differ because they were developed using different methodologies for distinct clinical contexts. We compared these documents. Methotrexate (MTX)-associated acute/subacute pneumonitis should be distinguished from its effects on the development or progression of chronic fibrotic RA-ILD. Recent documents no longer consider RA-ILD alone a uniform contraindication for MTX, although severe, newly developed, or progressive ILD and the risk of drug-induced lung injury require reassessment. Abatacept and rituximab are often favored among biologic/targeted synthetic disease-modifying antirheumatic drugs, whereas the use of interleukin-6, Janus kinase, and tumor necrosis factor inhibitors varies. Drug selection should distinguish RA activity control from ILD-directed therapy and be individualized through multidisciplinary discussions considering the RA activity, ILD severity/progression and imaging, pulmonary toxicity, infection risk, and alternatives.
Related
- Patient perspectives on simultaneous methotrexate-folic acid intake to improve adherence in rheumatoid arthritis: a cross-sectional survey.
- An Active Cytomegalovirus Infection and Epstein-Barr Virus Reactivation Complicated by Cytomegalovirus Meningitis and Virus-Associated Hemophagocytic Lymphohistiocytosis during Methotrexate and Upadacitinib Therapy in a Patient with Rheumatoid Arthritis
- Granulomatous Interstitial Nephritis Associated With Adalimumab Therapy in a Patient With Rheumatoid Arthritis: A Case Report
- Machine Learning Models to Predict Methotrexate Treatment Response in Rheumatoid Arthritis: A Scoping Review
- Screening for rheumatoid arthritis-associated interstitial lung disease using lung ultrasound: a systematic review and quality appraisal of recent studies
BibTeX
@article{yamakawa2026contemporary,
title = {{Contemporary Guideline Perspectives on Methotrexate and Biologic/Targeted Synthetic Disease-Modifying Antirheumatic Drugs (DMARDs) in Rheumatoid Arthritis-Associated Interstitial Lung Disease}},
author = {Hideaki Yamakawa and Masahiro Yokosawa},
journal = {Internal Medicine},
year = {2026},
month = aug,
doi = {10.2169/internalmedicine.8144-26},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_8144-26/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Contemporary Guideline Perspectives on Methotrexate and Biologic/Targeted Synthetic Disease-Modifying Antirheumatic Drugs (DMARDs) in Rheumatoid Arthritis-Associated Interstitial Lung Disease
AU - Hideaki Yamakawa
AU - Masahiro Yokosawa
PY - 2026
DA - 2026/08/25
JO - Internal Medicine
DO - 10.2169/internalmedicine.8144-26
UR - https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_8144-26/_article
AB - Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is an extra-articular manifestation that affects the patient outcomes. Published guidelines and consensus documents on RA-ILD or systemic autoimmune rheumatic disease/connective tissue disease-associated ILD have updated drug selection for RA-ILD; however, their meanings differ because they were developed using different methodologies for distinct clinical contexts. We compared these documents. Methotrexate (MTX)-associated acute/subacute pneumonitis should be distinguished from its effects on the development or progression of chronic fibrotic RA-ILD. Recent documents no longer consider RA-ILD alone a uniform contraindication for MTX, although severe, newly developed, or progressive ILD and the risk of drug-induced lung injury require reassessment. Abatacept and rituximab are often favored among biologic/targeted synthetic disease-modifying antirheumatic drugs, whereas the use of interleukin-6, Janus kinase, and tumor necrosis factor inhibitors varies. Drug selection should distinguish RA activity control from ILD-directed therapy and be individualized through multidisciplinary discussions considering the RA activity, ILD severity/progression and imaging, pulmonary toxicity, infection risk, and alternatives.
SN - 1349-7235
SN - 0918-2918
ER -