From the Guidelines
Treatment of Pulmonary Fibrosis Secondary to Scleroderma Overlapping with Rheumatoid Arthritis (RA)
For a patient with pulmonary fibrosis secondary to scleroderma overlapping with rheumatoid arthritis (RA), inhalers can be prescribed to alleviate symptoms of shortness of breath (SOB) attacks 1.
- A suitable option for inhalation therapy is a bronchodilator like tiotropium bromide 18mcg via inhalation once daily, which can help improve lung function and reduce symptoms of SOB 1.
- Alternatively, inhaled corticosteroids like fluticasone 250mcg twice daily may also be used to reduce inflammation, however, the primary treatment should focus on managing the underlying disease process 1.
- Antifibrotic agents like nintedanib may also be considered, which have been shown to slow down disease progression in patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD) 1.
- It is essential to note that the treatment approach should be individualized and multidisciplinary, involving both rheumatologists and pulmonologists, to ensure the best possible outcomes for patients with SSc-ILD overlapping with RA 1.
- The treatment plan should also include supportive interventions, such as rigorous anti-reflux therapy, treatment of dysphagia, smoking cessation, vaccinations, and oxygen therapy if necessary, to manage factors that may aggravate SSc-ILD 1.
From the Research
Treatment Options for Pulmonary Fibrosis Secondary to Scleroderma Overlapping with Rheumatoid Arthritis
- The treatment of pulmonary fibrosis secondary to scleroderma overlapping with Rheumatoid Arthritis (RA) involves managing the underlying conditions and alleviating symptoms such as shortness of breath (SOB) attacks.
- According to 2, in the chronic course of RA-associated interstitial lung disease (RA-ILD), the activity of ILD itself can be stabilized, considering the safety of each anti-rheumatic drug.
- The use of antifibrotic agents, such as nintedanib and pirfenidone, has been approved for patients with idiopathic pulmonary fibrosis and has shown clinical efficacy in patients with progressive fibrosing interstitial lung disease (PF-ILD) 3.
- In patients with systemic sclerosis (SSc) and RA, the diagnosis of interstitial lung disease (ILD) and the identification of 'progressive pulmonary fibrosis' can be made using chest CT scans 4.
- For lung fibrosis in SSc, clinical trial results support the use of immunosuppression, including high-intensity regimens with autologous stem cell transplantation, and new trials are underway to test other potential therapies 5.
- Cyclophosphamide and mycophenolate mofetil have been shown to be effective in the management of SSc-ILD, with comparable improvements in lung function 6.
Management of Shortness of Breath (SOB) Attacks
- While the provided studies do not directly address the use of inhalers for relieving SOB attacks in patients with pulmonary fibrosis secondary to scleroderma overlapping with RA, they do discuss the importance of managing the underlying conditions and alleviating symptoms.
- The use of oxygen therapy and pulmonary rehabilitation may be beneficial in managing SOB attacks, but the specific use of inhalers is not mentioned in the provided studies.
- Further research would be needed to determine the effectiveness of inhalers in relieving SOB attacks in this patient population.