Bước tiến mới trong chẩn đoán và điều trị bệnh phổi mô kẽ trong viêm khớp dạng thấp=Recent advances in the diagnosis and management of rheumatoid arthritis

Bước tiến mới trong chẩn đoán và điều trị bệnh phổi mô kẽ trong viêm khớp dạng thấp=Recent advances in the diagnosis and management of rheumatoid arthritis - associated interstitial lung disease

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Tác giả: Thanh Ngọc Cao, Khôi Nguyên Huỳnh

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.23-33

Bộ sưu tập: Metadata

ID: 245013

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Bệnh phổi mô kẽ (interstitial lung disease, ILD) là một tổn thương ngoài khớp nặng của viêm khớp dạng thấp (rheumatoid arthritis, RA), dẫn đến dự hậu xấu và giảm chất lượng cuộc sống của bệnh nhân. Các bước tiến mới trong chẩn đoán và điều trị ILD trong RA mang lại hy vọng trong việc chẩn đoán sớm và cải thiện hiệu quả điều trị cho bệnh nhân. Các yếu tố nguy cơ chính của bệnh phổi mô kẽ trong viêm khớp dạng thấp (rheumatoid arthritis-associated interstitial lung disease, RAILD) bao gồm nam giới, lớn tuổi, hút thuốc, di truyền và hoạt tính bệnh cao. Bên cạnh các dấu ấn đã biết như tốc độ máu lắng, CRP, RF và anti- CCP, các dấu ấn sinh học mới đang được nghiên cứu để hỗ trợ chẩn đoán và tiên lượng ILD trong RA, bao gồm các cytokine như Krebs von den Lungen-6 (KL-6). Chụp cắt lớp vi tính độ phân giải cao (HRCT) là tiêu chuẩn vàng trong chẩn đoán ILD. Hình ảnh đặc trưng trên HRCT kết hợp với các đặc điểm lâm sàng và xét nghiệm, giúp phân loại và đánh giá mức độ nặng của bệnh. Chẩn đoán sớm RA-ILD, đặc biệt là kiểu hình xơ hóa tiến triển giúp giảm tử suất và cải thiện tiên lượng cho bệnh nhân. Kiểm soát tốt hoạt động bệnh của RA giúp ngăn ngừa và làm chậm tiến triển của ILD. Corticoid có thể được sử dụng trong giai đoạn đầu giúp kiểm soát tình trạng viêm. Các nghiên cứu ghi nhận các thuốc ức chế miễn dịch, thuốc sinh học hoặc thuốc ức chế janus kinase (JAK) có thể mang lại hiệu quả cho bệnh nhân RA-ILD. Thuốc chống xơ hóa cũng được chứng minh có hiệu quả trong làm chậm tiến triển của ILD trong RA. Liệu pháp phối hợp điều hòa miễn dịch và chống xơ hóa hứa hẹn mang lại hiệu quả điều trị và cải thiện tiên lượng cho bệnh nhân RA-ILD. Các bước tiến mới trong chẩn đoán và điều trị RA-ILD đã mở ra triển vọng cải thiện tiên lượng và chất lượng cuộc sống cho bệnh nhân. Nghiên cứu và phát triển các phương pháp chẩn đoán và điều trị mới là rất cần thiết để tối ưu hóa kết quả điều trị cho bệnh nhân RA-ILD trong tương lai.Interstitial lung disease (ILD) is a severe extra-articular manifestation of rheumatoid arthritis (RA), leading to poor prognosis and reduced quality of life for patients. Recent advances in the diagnosis and treatment of ILD in RA offer hope for early diagnosis and improved treatment efficacy for patients. The main risk factors for RA-associated interstitial lung disease (RA-ILD) include male gender, older age, smoking, genetics, and high disease activity. In addition to known markers such as erythrocyte sedimentation rate (ESR), Creactive protein (CRP), rheumatoid factor (RF), and anti-cyclic citrullinated peptide (anti-CCP), new biomarkers are being studied to aid in the diagnosis and prognosis of ILD in RA, including cytokines such as Krebs von den Lungen-6 (KL- 6). High-resolution computed tomography (HRCT) is the gold standard for diagnosing ILD. Characteristic HRCT images, combined with clinical features and laboratory tests, help classify and assess the severity of the disease. Early diagnosis of RA-ILD, particularly the progressive fibrotic phenotype, reduces mortality and improves prognosis for patients. Effective control of RA disease activity helps prevent and slow the progression of ILD. Corticosteroids can be used in the early stages to control inflammation. Studies have noted that immunosuppressants, biologic agents, or janus kinase inhibitors (JAK) can be effective for RAILD patients. Antifibrotic drugs have also been shown to be effective in slowing the progression of ILD in RA. Combined immunomodulatory and antifibrotic therapy promises to provide effective treatment and improve prognosis for RA-ILD patients. Recent advances in the diagnosis and treatment of RA-ILD have opened up prospects for improving the prognosis and quality of life for patients. Research and development of new diagnostic and therapeutic methods are essential to optimize treatment outcomes for RA-ILD patients in the future.

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