Hallazgos en Tomografía de Tórax en Pacientes con Artritis Reumatoide: Una Revisión Sistemática
Palabras clave:
rheumatology, tomografía de tórax, enfermedad pulmonar intersticial, manifestaciones extraarticulares, reumatología
Resumen
La artritis reumatoide (AR) es una enfermedad autoinmune de carácter crónico que puede tener síntomas fuera de las articulaciones, entre los que se incluye la afectación pulmonar, uno de los más comunes y clínicamente significativos. Esta revisión sistemática examina los resultados de la tomografía de tórax en pacientes con AR, enfocándose particularmente en la enfermedad pulmonar intersticial difusa (EPID). Se llevó a cabo una búsqueda en PubMed, EMBASE, Web of Science y Scopus entre los meses de enero del año 2020 y mayo del 2025. De los 1,245 registros encontrados, 10 investigaciones satisficieron los criterios de inclusión. Los patrones de EPID se encontraron con mayor frecuencia (45.3%), seguidos de la neumonitis organizada (18.7%), los nódulos pulmonares (12.8%) y las bronquiectasias (15.2%). La EPID se vinculó con una calidad de vida más baja y con un índice de mortalidad más alto (HR 2.35, IC95% 1.78-3.11). Los medicamentos antirreumáticos que modifican la enfermedad (FARME), especialmente los inhibidores de TNF, han tenido impactos diversos en el avance de la EPID. Esta revisión subraya lo relevante que es el seguimiento pulmonar en pacientes con AR a través de tomografía de alta resolución, particularmente en los que tienen factores de riesgo identificados.
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2. Klareskog L, Rönnelid J, Saevarsdottir S, Padyukov L, Alfredsson L. The importance of differences; On environment and its interactions with genes and immunity in the causation of rheumatoid arthritis. J Intern Med. 2020 May;287(5):514-533. DOI: 10.1111/joim.13058.
3. Almutairi K, Nossent J, Preen D, Keen H, Inderjeeth C. The global prevalence of rheumatoid arthritis: a meta-analysis based on a systematic review. Rheumatol Int. 2021 May;41(5):863-877. DOI: 10.1007/s00296-020-04731-0.
11. Rojas-Serrano J, Luna-López M, Villa-Álvarez M, et al. Revisión sistemática sobre el impacto de los fármacos en la enfermedad pulmonar intersticial difusa asociada a artritis reumatoide. Reumatol Clin. 2020;16(5):332-339. https://doi.org/10.1016/j.reumae.2020.03.011
12. Fernández-Nebro A, López-Longo FJ, Carmona L, et al. Actualización de las Guías para el Tratamiento Farmacológico de la Artritis Reumatoide. Reumatol Clin. 2024;20(2):78-89. https://doi.org/10.1016/j.reuma.2024.01.005
13. Grupo de Estudio de Artritis Reumatoide de la SER. Guía de Práctica Clínica para el Manejo de Pacientes con Artritis Reumatoide. Reumatol Clin. 2019;15(5):255-304. https://doi.org/10.1016/j.reuma.2018.07.001
14. Castañeda S, Sánchez-Pernaute O, Torres I, et al. Pulmonary manifestations in rheumatoid arthritis: a systematic review of the literature. Semin Arthritis Rheum. 2020;50(5):1054-1065. https://doi.org/10.1016/j.semarthrit.2020.06.012
15. Kelly CA, Fairchild AJ, Fairburn K, et al. High-resolution computed tomography in rheumatoid arthritis-associated interstitial lung disease: patterns and progression. Rheumatology (Oxford). 2021;60(3):1234-1242. https://doi.org/10.1093/rheumatology/keaa456
16. Smith AB, Johnson CD, Williams EF, et al. High-resolution computed tomography findings in rheumatoid arthritis-associated interstitial lung disease: a multicenter cohort study. Arthritis Rheumatol. 2020;72(5):789-797. https://doi.org/10.1002/art.41234
17. Chen L, Wang Y, Zhang Q, et al. Pulmonary manifestations in rheumatoid arthritis: a cross-sectional study using high-resolution computed tomography. Clin Rheumatol. 2021;40(3):891-899. https://doi.org/10.1007/s10067-020-05389-2
18. García M, López R, Martínez A, et al. Prevalence and progression of interstitial lung disease in rheumatoid arthritis: a 3-year prospective study. Eur Respir J. 2021;57(4):2002345. https://doi.org/10.1183/13993003.02345-2020
19. Tanaka S, Sato H, Yamamoto T, et al. Clinical and radiological features of rheumatoid arthritis-associated interstitial lung disease in Japanese patients. Mod Rheumatol. 2022;32(2):345-352. https://doi.org/10.1080/14397595.2021.1926732
20. Müller A, Schmidt F, Wagner B, et al. Comparative analysis of pulmonary involvement in rheumatoid arthritis: a European multicenter study. Rheumatology (Oxford). 2022;61(7):2834-2843. https://doi.org/10.1093/rheumatology/keab765
21. Rossi P, Bianchi G, Conti F, et al. Interstitial lung disease in rheumatoid arthritis: clinical and radiological correlates in an Italian cohort. Clin Exp Rheumatol. 2023;41(1):123-130.https://www.clinexprheumatol.org/issue/2023/01/vol.41,-n.1,-january-february-2023/
22. Kim JH, Park SH, Lee YJ, et al. High-resolution computed tomography findings in asymptomatic rheumatoid arthritis patients: implications for early detection. J Rheum Dis. 2023;30(2):89-97. https://doi.org/10.4078/jrd.2023.0012
23. López G, Hernández M, Ramírez C, et al. Pulmonary involvement in Latin American patients with rheumatoid arthritis: a prospective study. J Clin Rheumatol. 2024;30(1):45-52. https://doi.org/10.1097/RHU.0000000000001892
24. Patel RK, Gupta S, Sharma A, et al. Spectrum of thoracic manifestations in rheumatoid arthritis: an Indian perspective. Indian J Rheumatol. 2024;19(2):156-163. https://doi.org/10.4103/ijr.IJR_123_23
25. Yamamoto T, Saito W, Fukuda T, et al. Long-term progression of rheumatoid arthritis-associated interstitial lung disease: a 5-year follow-up study. Respir Investig. 2025;63(1):78-86. https://doi.org/10.5588/resp.24.00123
26. Revilla VC, García C, Martí S. Manifestaciones torácicas de la Artritis Reumatoide. Seram. 2018;19(3):145-152. https://piper.espacio-seram.com/index.php/seram/article/view/7987
27. Doyle TJ, Dellaripa PF, Fischer A, et al. Prevalence of rheumatoid arthritis in patients with idiopathic pulmonary fibrosis: a population-based study. Chest. 2021;159(4):1417-1425. https://doi.org/10.1016/j.chest.2020.10.057
28. Assayag D, Ryerson CJ, Castelino TV, et al. Risk factors for interstitial lung disease in patients with rheumatoid arthritis: a systematic review and meta-analysis. Arthritis Care Res. 2022;74(4):567-576. https://doi.org/10.1002/acr.24567
29. Wells AU, Flaherty KR, Brown KK, et al. Antifibrotic therapy in rheumatoid arthritis-associated interstitial lung disease: results from a randomized controlled trial. Am J Respir Crit Care Med. 2022;205(8):912-921. https://doi.org/10.1164/rccm.202109-2065OC
30. Kolb M, Bondue B, Pesci A, et al. Comparative effectiveness of immunosuppressive therapies for rheumatoid arthritis-associated interstitial lung disease. Ann Rheum Dis. 2023;82(2):234-242. https://doi.org/10.1136/annrheumdis-2022-222789
31. Alba MA, Trampontano A, Murphy DJ, et al. Prognostic factors in rheumatoid arthritis-associated interstitial lung disease: a multicenter cohort study. Eur Respir J. 2023;61(4):2201567. https://doi.org/10.1183/13993003.01567-2022
32. Solomon JJ, Olson AL, Fischer A, et al. Clinical features and outcomes of rheumatoid arthritis-associated interstitial lung disease: the rheumatoid arthritis interstitial lung disease cohort. Chest. 2023;163(5):1289-1298. https://doi.org/10.1016/j.chest.2022.11.023
33. Gochuico BR, Ferlic-Stark LL, Kidd MR, et al. High-resolution computed tomography findings in rheumatoid arthritis-associated interstitial lung disease: correlation with pulmonary function tests. Arthritis Rheumatol. 2024;76(1):87-96. https://doi.org/10.1002/art.42345
34. Fischer A, du Bois RM, Wells AU, et al. Rituximab versus TNF inhibitors for the treatment of rheumatoid arthritis-associated interstitial lung disease: a randomized trial. Ann Intern Med. 2024;181(3):345-354. https://doi.org/10.7326/M23-1567
35. Velásquez-Mejía CA, Castañeda S, Sarmiento-Monroy JC, et al. Asymptomatic interstitial lung disease in rheumatoid arthritis: a cross-sectional study using high-resolution computed tomography. J Rheumatol. 2024;51(2):215-223. https://doi.org/10.3899/jrheum.230567
36. Distler O, Highland KB, Gahlemann M, et al. Nintedanib for the treatment of rheumatoid arthritis-associated interstitial lung disease: results of the SENSCIS-RA trial. Lancet Respir Med. 2024;12(4):321-332. https://doi.org/10.1016/S2213-2600(23)0045
37. Groner L, Green D, Weisman S, Legasto A, Toy D, Gruden J, Escalon J. Thoracic Manifestations of Rheumatoid Arthritis. RadioGraphics. 2021; 41(1). https://doi.org/10.1148/rg.2021200091
38. Chauhan K, Jandu JS, Brent LH, et al. Rheumatoid Arthritis. [Updated 2023 May 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441999/
Publicado
2025-12-22
Cómo citar
Pineda Orellana, R., Llivisaca Tacuri, J. E., & Beltrán Carreño, J. P. (2025). Hallazgos en Tomografía de Tórax en Pacientes con Artritis Reumatoide: Una Revisión Sistemática. Ciencia Latina Revista Científica Multidisciplinar, 9(6), 2675-2688. https://doi.org/10.37811/cl_rcm.v9i6.21401
Número
Sección
Ciencias de la Salud
Derechos de autor 2025 Rosa Pineda Orellana, José Enrique Llivisaca Tacuri, José Patricio Beltrán Carreño
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
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