Interstitial lung disease in rheumatoid arthritis:Current concepts in pathogenesis,diagnosis and therapeutics

Rheumatoid arthritis(RA) is the most common chronic autoimmune inflammatory joint disease. RA-associated interstitial lung disease(RA-ILD) is a major extraarticular complication and causes symptoms that lead to a deterioration in the quality of life, high utilization of health resources, and an increased risk of earlier mortality. Early in the course of RA-ILD, symptoms are highly variable, making the diagnosis difficult. Therefore, a rational diagnostic strategy that combines an adequate clinical assessment with the appropriate use of clinical tests, including pulmonary function tests and high-resolution computed tomography, should be used. In special cases, lung biopsy or bronchioalveolar lavage should be performed to achieve an early diagnosis. Several distinct histopathological subtypes of RA-ILD are currently recognized. These subtypes also have different clinical presentations, which vary in therapeutic response and prognosis. This article reviews current evidence about the epidemiology of RA-ILD and discusses the varying prevalence rates observed in different studies. Additionally, aspects of RA-ILD pathogenesis, including the role of cytokines and other molecules such as autoantibodies, as well as the evidence linking several drugs used to treat RA with lung damage will be discussed. Some aspects of the clinical characteristics of RA-ILD are noted, and diagnostic strategies are reviewed. Finally, this article analyzes current treatments for RA-ILD, including immunosuppressive therapies and biologic agents, as well as other therapeutic modalities. The prognosis of this severe complication of RA is discussed. Additionally, this paper examines updated evidence from studies identifying an association between drugs used for the treatment of RA and the development of ILD.

Progress in the pathogenesis and treatment of rheumatoid arthritis with sleep apnea hypopnea syndrome

Objective:Sleep apnea hypopnea syndrome (SAHS) is a common sleep disorder, which is manifested as a reduction in tidal volume or apnea during sleep, which results in intermittent hypoxia and tissue hypoxia and induces oxidative stress and inflammatory responses. Rheumatoid arthritis (RA) is a systemic disease contributing to hyperplasia of synovial membrane, cartilage erosion and joint damage. Fibroblast like synoviocytes (FLS), which make up the lining of the synovial membrane, are believed to play a role in the pathogenesis of RA. RA is a series of inflammation-like responses that induce joint damage and dysfunction and impair patients' life quality. This article first introduced the basic features of RA and analyzes the pathogenesis of RA with SAHS. Then the relationship between RA and SAHS was investigated. Finally, the progress in the treatment for RA with SAHS was reviewed emphatically.

TCM Treatment of Rheumatoid Arthritis by Supplementing the Kidney and Invigorating the Blood Circulation

The therapeutic effects in treating the intermediate and late rheumatoid arthritis by supplementing the kidney and invigorating blood circulation were observed. In the 43 cases of the treatment group, No. 2 Qu Feng Shi Ling capsules (祛风湿灵胶囊2号) and Fenbid (芬必得) were prescribed, while in the 39 cases of the control group Lei Gong Teng Tablets (雷公藤总甙片) and Fenbid were given. The results showed that the total effective rate in the treatment group was more satisfactory than that in the control (P<0.05 or P<0.01). With less toxic effects, the former could better improve the local swelling and lower the blood viscosity.

Systematic review of robust experimental models of rheumatoid arthritis for basic research

Rheumatoid arthritis(RA)is a common autoimmune disease characterized by progressive joint inflammation and destruction,deformity,loss of mobility,and permanent disability.Although the cellular and molecular mechanisms involved in RA are understood in detail,no drugs or therapies can completely cure RA.Many long-term efforts have been directed towards a better understanding of RA pathogenesis and the development of new classes of therapeutics.Thus,the ongoing elucidation of pathogenic events underlying RA mostly relies on studies of animal models.Herein,we comprehensively review and discuss the characteristics,challenges,and unresolved of issues of various experimental models of RA to provide a basis and reference for the rational selection of experimental RA models for basic investigations into traditional Chinese medicine(TCM).

Inhibition of cyclooxygenase-2 activity in subchondral bone modifies a subtype of osteoarthritis

Osteoarthritis(OA) causes the destruction of joints. Its pathogenesis is still under investigation, and there is no effective diseasemodifying therapy. Here, we report that elevated cyclooxygenase-2(COX-2) expression in the osteocytes of subchondral bone causes both spontaneous OA and rheumatoid arthritis(RA). The knockout of COX-2 in osteocytes or treatment with a COX-2 inhibitor effectively rescues the structure of subchondral bone and attenuates cartilage degeneration in spontaneous OA(STR/Ort)mice and tumor necrosis factor-α transgenic RA mice. Thus, elevated COX-2 expression in subchondral bone induces both OAassociated and RA-associated joint cartilage degeneration. The inhibition of COX-2 expression can potentially modify joint destruction in patients with arthritis.

May Traditional Chinese Medicine Reduce the Risk of Developing Rheumatoid Arthritis?An One-armed Prospective Study

Background:Rheumatoid arthritis(RA)is a worldwide public health problem.Intervention and prevention before the onset of rheumatic diseases is a new direction in current research.Objective:The aim of this study was to evaluate the potential and feasibility of traditional Chinese medicine(TCM)in the prevention of RA.Methods:This was a single-armed prospective clinical trial.All participants were recruited from a single center in Guangdong,China.Adults who were tested positive for anti-cyclic citrullinated peptide antibody(anti-CCP)and/or rheumatoid factor(RF),had no synovitis and never been treated with disease-modifying anti-rheumatic drugs(DMARDs),were enrolled to take the Huayu-Qiangshen-Tongbi(HQT)decoction orally twice daily,200 mL each time for 24 weeks.Primary outcome was the proportion of patients who met 2010 ACR(American College of Rheumatology)/EULAR(European League Against Rheumatism)classification criteria of RA during observation.Secondary outcomes included levels of anti-CCP,RF,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),assessment of signs and symptoms,and radiographic progression by magnetic resonance imaging(MRI).Results:19 individuals were enrolled in the study,4 of which withdrew because of the epidemic of COVID-19.During the observation period,3 individuals(20%)developed RA and they had longer morning stiffness(P=0.009)and more obvious synovial enhancement in MRI(P=0.041)at baseline when compared with those who did not develop RA.After 24 weeks of intervention,there were improvements in 28-swollen joint count(SJC28)(P=0.046),Visual Analog Scale(VAS)(P=0.019),Patient’s Global Assessment(PtGA)(P=0.019)and Physician’s Global Assessment(PGA)(P=0.031),but no statistical significance was observed in the levels of anti-CCP,RF,ESR,CRP,morning stiffness,28-tender joint count(TJC28),Health Assessment Questionnaire(HAQ)and magnetic resonance imaging(MRI)analysis(P>0.05).Conclusion:The HQT formula is safe and could improve joint symptoms and signs in these at-risk individuals,but it remains to be investigated in futher study to see if it might potentially reduce the risk of developing RA.Besides,for individuals at high risk to develop RA,morning stiffness and synovial enhancement in MRI might be predictive factors and warning signs.

Programmed cell death 5 correlates with disease activity and interleukin-17 in serum and synovial fluid of rheumatoid arthritis patients

Background Programmed cell death 5 （PDCD5） is a novel apoptotic regulatory gene that promotes apoptosis in various tumor cells. Studies have shown that PDCD5 accelerates the apoptosis of synoviocytes in vitro, implying a potential role in rheumatoid arthritis （RA） pathogenesis. This study examined the expression of PDCD5 in serum and synovial fluid of RA patients, its effect on the expression of inflammatory cytokine, interleukin-17 （IL-17）, and the assessment of disease activity in RA. Methods PDCD5 and IL-17 levels in serum and synovial fluid from 18 patients with RA and 22 patients with osteoarthritis （OA） were detected using enzyme-linked immunosorbent assay （ELISA）. Concentrations of serum PDCD5 in 40 healthy people were also detected as controls. As disease activity indices, C-reactive protein （CRP）, erythrocyte sedimentation rate （ESR）, rheumatoid factor （RF）, and X-ray grading scale were also evaluated. Results Serum and synovial fluid PDCD5 levels in RA patients were significantly higher than those in OA and healthy controls. Serum PDCD5 level was inversely correlated to CRP and ESR, and was significantly higher in the RF negative group than in the positive group. PDCD5 level was also negatively correlated with IL-17 levels both in serum and synovial fluid of RA patients. However, differences in synovial fluid PDCD5 level from RA patients at different Larsen stages were not detectable. Conclusions PDCD5 affects RA pathogenesis. Insufficient apoptosis of fibroblast-like synoviocytes and inflammatory cells in RA could increase the expression of PDCD5 protein. As PDCD5 levels correlated negatively with disease activity indices and IL-17 level, PDCD5 could become a target in the diagnosis and treatment of RA.

Integrating 16S sequencing and metabolomics study on anti-rheumatic mechanisms against collagen-induced arthritis of Wantong Jingu Tablet

Wantong Jingu Tablet(WJT),a mixture of traditional Chinese medicine,was reported to relieve the symptoms of rheumatoid arthritis(RA),but its pharmacological mechanism was not completely understood.The aim of this study was to investigate the therapeutic mechanisms of WJT for RA in vivo.The effects of WJT on joint pathology,as well as the levels of Bax,Bcl-2,caspase-3,cleaved-caspase-3,ERK1/2,pERK1/2,TNF-α,IL-1β,and IL-6 were measured using collagen-induced arthritis(CIA)rats.The intestinal flora composition and the metabolites alteration were analyzed by 16S rDNA sequencing and metabolomics method,respectively.We found that WJT ameliorated the severity of the CIA rats which might be mediated by inducing apoptosis,inactivating the MEK/ERK signals and reducing the production of pro-inflammatory cytokines.WJT,in part,relieved the gut microbiota dysbiosis,especially bacterial phylum Bacteroidetes,Tenericutes and Deferribacteres,as well as bacterial genus Vibrio,Macrococcus and Vagococcus.3’-N-debenzoyl-2’-deoxytaxol,tubulysin B,and magnoline were significantly associated with the specific genera.We identified serotonin,glutathione disulfide,N-acetylneuraminic acid,naphthalene and thromboxane B2 as targeted molecules via metabolomics.Our findings contributed to the understanding of RA pathogenesis,and WJT played essential roles in gut microbiota health and metabolite modulation in the CIA rats.

Role of IL-2/IL-2 receptor in pathogenesis of autoimmune disorders:Genetic and therapeutic aspects

Interleukin-2(IL-2)is an important cytokine that plays a key role in the immune response.The IL-2 receptor(IL-2R)is composed of three subunits,alpha,beta,and gamma,with the alpha subunit having the highest affinity for IL-2.Several studies reported that immune dysregulation of IL-2 may cause tissue injury as well as damage leading to the pathogenesis of various autoimmune diseases such as acute necrotizing vasculitis in systemic lupus erythematosus(SLE),inflammatory synovitis in rheumatoid arthritis(RA),salivary and lacrimal gland dysfunction in Sjogren syndrome(SS),obliterative vasculopathy fibrosis in systemic sclerosis(SSc),and inflammatory demyelination in multiple sclerosis(MS).The aim of this review paper was to examine the role of IL-2/IL-2R in various autoimmune disorders,taking into account recent advancements and discoveries,gaps in the current literature,ongoing debates,and potential avenues for future research.The focus of this review is on systemic lupus erythematosus,rheumatoid arthritis,systemic sclerosis,sjogren syndrome,and multiple sclerosis,which are all linked to the malfunctioning of IL-2/IL-2R.In genetic studies,gene polymorphisms of IL-2 such as IL-2330/T,IL-2330/G,and rs2069763 are involved in increasing the risk of SLE.Furthermore,genetic associations of IL-2/IL-2R such as rs791588,rs2281089,rs2104286,rs11594656,and rs35285258 are significantly associated with RA susceptibility.The IL-2 polymorphism including rs2069762A,rs6822844T,rs6835457G,and rs907715T are significant connections with systemic sclerosis.In addition,rs2104286(IL-2),rs11594656(IL-2RA),rs35285258(IL-2RB)gene polymorphism significant increases the risk of multiple sclerosis.In therapeutic approaches,low-dose IL-2 therapy could regulate Tfr and Tfh cells,resulting in a reduction in disease activity in the SLE patients.In addition,elevated sIL-2R levels in the peripheral blood of SLE patients could be linked to an immunoregulatory imbalance,which may contribute to the onset and progression of SLE.Consequently,sIL-2R could potentially be a target for future SLE therapy.Moreover,Low dose-IL2 was well-tolerated,and low levels of Treg and high levels of IL-21 wereassociated with positive responses to Ld-IL2 suggested to be a safe and effective treatment for RA.Additionally,low-dose IL-2 treatment improves the exocrine glands'ability to secrete saliva in SS-affected mice.Whereas,Basiliximab targets the alpha chain of the IL-2 receptor suggested as a potential treatment for SSc.Also,pre-andpost-treatment with Tregs,MDSCs,and IL-2 may have the potential to prevent EAE induction in patients with MS.It is suggested that further studies should be conducted on IL-2 polymorphism in Sjogren syndrome.

基于“心受气于脾”论治类风湿关节炎累及心脏病变

类风湿关节炎累及心脏病变属于复合病证,根据其发病过程与临床表现,可归属于中医学“脏痹-心痹”。心痹为痹证日久缠绵不愈,复感风、寒、湿邪,向内传入于心所致。该文基于“心受气于脾”理论探讨其病因、病机与治疗。通过梳理古代文献,发现类风湿关节炎累及心脏病变的病因为脾气不足,卫阳不固,外感风、寒、湿邪气侵入机体,瘀血顽痰阻滞发为心痹。其病机为脾气不足,营卫虚弱;脾阳不足,痰浊内生;脾失健运,痰瘀互结。现代研究表明,细胞免疫失调、血脂异常以及血凝与类风湿关节炎合并心脏病变关系密切,这与中医病机一致。在治疗时选用补益卫阳,和营通痹;温阳散寒,化痰逐饮;益气活血,健脾祛痰之法,代表方剂分别为黄芪桂枝五物汤、苓桂术甘汤、赤茯苓汤。该文提出“心受气于脾”理论,为临床治疗类风湿关节炎累及心脏病变提供思路与指导。

不同辨证体系中类风湿关节炎中医病机研究进展

类风湿关节炎属于一种以周围关节骨质损害为主要特征的自身免疫性疾病。中医学对其曾多以病因角度辨证,且多从风、寒、湿、热论治,其他辨证体系涉及较少。近年来,类风湿关节炎病机的相关研究得到广泛重视,其辨证体系和角度的探索也得到进一步拓展。该文对近年发表的有关中医治疗类风湿关节炎的文献进行梳理总结,从脏腑理论、气血津液理论及络病理论共三种辨证体系论述其论治研究进展。期望通过该文的归纳、分类与总结,为今后类风湿关节炎的病机研究和证型分类提供参考和思路。

类风湿关节炎中医证候客观化研究

目的探究类风湿关节炎(RA)相关指标与中医证型之间的关系。方法选取RA患者300例,根据中医辨证分型的不同将其分为湿热痹阻证、寒湿痹阻证、肾气虚寒证、肝肾阴虚证和瘀血痹阻证5个证型,每个证型60例。分析各个证型患者的临床表现、免疫学指标、检验学指标与各个证型之间的联系。结果中医证候在关节肿胀、关节疼痛、关节畸形3种临床表现方面,差异有统计学意义(P<0.05);各证型RA患者的类风湿因子(RF)、抗环瓜氨酸多肽(CCP)抗体、红细胞沉降率(ESR)、C反应蛋白(CRP)、血小板计数(PLT)、D-二聚体(DD)等指标之间比较,差异无统计学意义(P>0.05)。结论类风湿关节炎严重程度与各指标无明显相关性;各指标与中医证候无明显相关性。中医治疗各个证型的RA患者主要原则是活血化瘀,并贯穿于整个治疗过程。

中药离子导入治疗类风湿关节炎诊疗方案技术规范

类风湿关节炎是一种以炎性滑膜炎为主的慢性系统性疾病,特征是手、足小关节的多关节、对称性、侵袭性关节炎症,并常伴有关节外器官受累。类风湿关节炎可导致关节内软骨和骨的破坏、关节功能障碍,甚至残废。中药离子导入治疗类风湿关节炎具有独特优势。中药离子导入治疗不仅关注类风湿关节炎患者疾病的治疗,更注重其身体的整体调理。通过中药的调理作用,可以帮助类风湿关节炎患者改善体质,增强免疫力,从而更好地抵御疾病的侵袭。这种整体的治疗观念与现代医学的身心兼治理念相契合,使中药离子导入治疗在类风湿关节炎中具有更广泛的应用前景。本技术规范从类风湿关节炎临床表现、分类标准、中医诊断入手,将中药离子导入治疗类风湿关节炎的特点、适应证、药物选择、操作步骤、注意事项、科学评价及推广应用等方面进行规范总结,可为中医师、康复治疗师等开展中药离子导入治疗类风湿关节炎提供操作指导,具有良好的临床适用性、安全性及有效性。

类风湿关节炎患者中医证型特点与Th17/Treg平衡和疾病活动度的关系

目的:探讨类风湿关节炎(RA)患者中医证型特点及与辅助性T细胞17(Th17)/调节性T细胞(Treg)平衡和疾病活动度的关系。方法:以2022年3月~2024年2月217例RA患者作为病例组,并选取同期健康体检志愿者100名为对照组,比较两组Th17细胞、Treg细胞、Th17/Treg及其相关因子[白细胞介素-17(IL-17)、IL-23]水平。依据中医证型将患者分为湿热痹阻证(108例)、寒湿痹阻证(43例)、痰瘀痹阻证(35例)、肝肾亏虚证(31例),比较各组患者临床特征分布情况、Th17/Treg及其相关因子、28个疾病活动度(DAS28)。结果:病例组Th17细胞、Th17/Treg及其相关因子水平高于对照组,Treg细胞低于对照组(P<0.05)。4种中医证型RA患者关节肿胀数、关节压痛数计病程存在显著差异(P<0.05);4种中医证型RA患者Treg、Th17细胞水平、Th17/Treg、IL-17、IL-23及DAS28水平存在显著差异(P<0.05)。4种证型RA患者DAS28评分等级差异具有统计学意义(P<0.05);其中湿热痹阻证、寒湿痹阻证RA患者高疾病活动度占比最高,痰瘀痹阻证、肝肾亏虚证RA患者中疾病活动度占比最高。结论:不同中医证型的RA患者外周血存在Th17/Treg细胞失衡,同时Th17/Treg细胞相关因子也表达异常;不同的中医证型患者间活动度存在明显的差异;RA患者的中医证型与Th17/Treg平衡和疾病活动度有关。

新疆北疆地区类风湿关节炎患者中医证候分布规律及不同证型IL-1β、BMP6的差异性分析

目的:探究新疆北疆地区类风湿关节炎(RA)的中医证候分布规律及其与相关因子的内在关系,为类风湿关节炎的治疗提供帮助。方法:收集北疆地区类风湿关节炎患者217例,对其中医证型、舌苔、脉象、症状、病程、DAS28疾病活动度及用ELISA法测得的IL-1β、BMP6等指标进行统计分析。结果:RA患者女性多于男性,中医证型比例为寒湿痹阻证>肝肾不足证>痰瘀痹阻证>湿热痹阻证>风湿痹阻症>气血两虚证,不同中医证型RA患者性别、年龄分布无统计学差异(P>0.05),该地区RA患者主要证候特点以关节晨僵、关节痛有定处、关节疼痛喜按、遇寒痛增、阴雨天加重、日轻夜重、关节屈伸不利、腰膝酸软、肢体沉重等症状较为常见,不同证型间的病程、DAS28疾病活动度、C反应蛋白、BMP6存在统计学差异(P<0.05),IL-6、IL-1β、RF、抗环瓜氨酸多肽抗体不存在统计学差异(P>0.05)。与其他证型相比,风湿痹阻症的C反应蛋白高于肝肾不足证、寒湿痹阻证的DAS28疾病活动度水平高于肝肾不足证、湿热痹阻证的BMP6水平高于风湿痹阻证、寒湿痹阻证,痰瘀痹阻证BMP6水平高于风湿痹阻证。结论:新疆北疆地区的RA患者中医证候特点以“寒”“湿”“虚”为主,证型以寒湿痹阻证最为多见,且疾病活动度较高,湿热痹阻证及痰瘀痹阻证的骨关节异常表现较为突出,BMP6水平相对较高。年龄和性别对RA的发病有影响,病程长短对RA的中医证型分布有影响。

寒湿痹阻型类风湿性关节炎治疗的研究进展

类风湿性关节炎(RA)是一种慢性全身性自身免疫疾病,目前发病机制尚未明确。西医治疗以有效快速地治疗疾病为目标,主要是通过多种药物联合治疗、手术治疗等手段来改善患者的症状,但从长远来看不良反应较为明显。RA在中医学中归属于痹症范畴,其中以寒湿痹阻型最为多见,中医药治疗以“调养”为主,往往疗效稳定、温和安全且费用低廉。中西医结合治疗,取长补短,具有减毒增效的优势。现从RA的发病机制、中医及中西医联合治疗综述如下,为临床治疗本病提供参考。

类风湿关节炎与代谢综合征的中医诊疗特点

类风湿关节炎(Rheumatoid Arthritis,RA)与代谢综合征(Metabolic Syndrome,MS)均为慢性全身性疾病,RA早期表现为关节肿胀、疼痛甚至关节变形,患者出现一系列活动受限症状,其病理本质是滑膜的炎性病变。MS早期表现为体力降低,身体沉重,头脑发昏等,进而出现功能受损症状,其核心特征为胰岛素抵抗。但RA与MS进入疾病后期均可出现肢体肿胀,腰膝酸软,胸闷气短,心悸失眠等临床症状。笔者通过查阅相关研究文献及收集大量临床诊疗经验可得知,RA与MS发病的病因病机与肝、脾、肾三脏密切相关。肝失疏泄,肝失所养,脾失健运,脾气虚弱,肾精亏虚等均可导致RA与MS的发生。本文将首先从肝、脾、肾三脏的角度出发,着重探讨RA与MS的发病机制。此外,肝、脾、肾受损日久可导致病理产物痰、湿、瘀血的产生,痰、湿、瘀血痹阻关节筋骨可加重RA患者的疼痛,痹阻日久还可使患者代谢功能受损,进而导致MS的发生。故可得知RA与MS病因病机其本在肾,与肝脾关系密切,其标为痰、湿、瘀血,属于本虚标实之病。临床中采用肝脾肾同调,痰湿瘀共治的标本兼治,消补兼施的中医特色治疗,可达到较好的治疗效果。

类风湿关节炎合并骨质疏松症分子信号通路机制的研究进展

骨质疏松症(OP)是类风湿关节炎(RA)最常见的共病之一。RA合并OP会加重骨破坏,增加骨折风险,降低患者的生活质量,增加社会负担。其病因复杂,发病机制尚不完全清楚。RA合并OP的治疗是目前临床工作的难点。了解疾病的信号通路,可以为疾病诊疗提供新的手段。该文对RA合并OP分子信号通路机制的研究进展作一综述。

隔药灸联合中医五行手指操治疗寒湿痹阻型类风湿关节炎的疗效观察

目的探讨隔药灸联合中医五行手指操改善寒湿痹阻型类风湿关节炎(rheumatoid arthritis,RA)的临床疗效。方法将90例寒湿痹阻型RA患者随机分为对照组和观察组,每组45例。对照组予以来氟米特片、艾拉莫德片、塞来昔布胶囊口服;观察组在对照组基础上行隔药灸联合中医五行手指操,其中隔药灸选取脾俞、阳陵泉、腰阳关、命门及手阳明大肠经、手少阳三焦经、手太阳小肠经上的阿是穴,每日1次,每次30 min。两组均治疗10 d。分别于治疗前后观察两组患者的疼痛视觉模拟评分(visual analogue scale,VAS)、炎症指标红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)、焦虑自评量表(self-rating anxiety scale,SAS)、健康评估问卷(health assessment questionnaire,HAQ)、中医证候积分,并于治疗后评定两组患者的临床疗效。结果治疗后,两组患者的VAS、ESR、CRP、SAS、HAQ及中医证候积分均较治疗前降低(P<0.05,P<0.01),且观察组上述指标均低于对照组(P<0.05,P<0.01)。观察组总有效率为80.00%,高于对照组的55.56%(P<0.01)。结论隔药灸联合中医五行手指操能改善寒湿痹阻型RA患者临床症状,提高患者生存质量。

真实世界中医治疗下类风湿关节炎合并间质性肺病的特征分析

目的 基于真实世界类风湿关节炎(rheumatoid arthritis,RA)临床队列探讨中医药干预下RA合并间质性肺病(interstitial lung disease,ILD)的临床特征及影响因素。方法 本研究选取2019年10月至2023年7月在“中国中医风湿病注册研究信息平台”注册的RA患者,采用回顾性巢式病例对照研究,根据观察截止时RA患者是否合并ILD分组,收集比较两组患者基线人口学特征、病情评估、实验室检查、中医证候、处方等资料,并探讨RA-ILD的相关影响因素。结果 共纳入4 068例RA患者,其中RA-ILD组678例,RA-nonILD组3 390例。湿热痹阻证是RA-ILD的主要证候类型(33.2%),且RA-ILD多兼瘀血阻络证、痰瘀痹阻证。Logistics分析表明年龄≥50岁、类风湿因子(rheumatoid factors,RF)高滴度阳性、抗环瓜氨酸肽(cyclic citrullinated peptide,CCP)抗体高滴度阳性、晨僵、乏力、白细胞升高、高密度脂蛋白降低、血糖升高是RA-ILD的相关危险因素,使用中药、中药+西药是RA-ILD的相关保护因素。结论 针对高龄伴晨僵、乏力,RF、抗CCP抗体高滴度阳性,白细胞升高、高密度脂蛋白降低、血糖升高的RA患者应尽早开展定期肺功能检查,早期识别RA-ILD的发生风险,同时应重视中药和中西药在RA-ILD发生发展中的保护作用。