Interstitial lung disease (ILD) is a common pulmonary complication of rheumatoid arthritis (RA), causing significant morbidity and mortality. Optimal treatment for RA-ILD is not yet well defined. Reliable prognostic indicators are largely byproducts of prior ILD progression, including low or decreasing forced vital capacity and extensive or worsening fibrosis on imaging. In the absence of validated tools to predict treatment response, decisions about whether to initiate or augment treatment are instead based on clinical judgment. In general, treatment should be initiated in patients who are symptomatic, progressing, or at high risk of poor outcomes. Retrospective data suggest that mycophenolate mofetil, azathioprine, and rituximab are likely effective therapies for RA-ILD. Abatacept is also emerging as a potential first-line treatment option for patients with RA-ILD. Further, recent data demonstrate that immunosuppression may be beneficial even in patients with a usual interstitial pneumonia (UIP) pattern on imaging, suggesting that immunosuppression should be considered irrespective of imaging pattern. Recent randomized controlled trials have shown that antifibrotic medications, such as nintedanib and likely pirfenidone, slow forced vital capacity decline in RA-ILD. Consideration can be given to antifibrotic initiation in patients progressing despite immunosuppression, particularly in patients with a UIP pattern. Future research directions include developing tools to predict which patients will remain stable from patients who will progress, discriminating patients who will respond to treatment from nonresponders, and developing algorithms for starting immunosuppression, antifibrotics, or both as first-line therapies.

间质性肺疾病（ILD）是类风湿性关节炎（RA）的常见肺部并发症，导致显着的发病率和死亡率。RA-ILD 的最佳治疗尚未明确。可靠的预后指标主要是先前 ILD 进展的副产品，包括用力肺活量低或下降以及影像学上广泛或恶化的纤维化。在缺乏预测治疗反应的有效工具的情况下，是否开始或加强治疗的决定取决于临床判断。一般来说，应该对有症状、病情进展或预后不良的高风险患者开始治疗。回顾性数据表明吗替麦考酚酯、硫唑嘌呤和利妥昔单抗可能是治疗 RA-ILD 的有效疗法。阿巴西普也正在成为 RA-ILD 患者潜在的一线治疗选择。此外，最近的数据表明，即使对于影像学上常见的间质性肺炎（UIP）模式的患者，免疫抑制也可能是有益的，这表明无论影像学模式如何，都应考虑免疫抑制。最近的随机对照试验表明，抗纤维化药物，例如尼达尼布和吡非尼酮，可以减缓 RA-ILD 患者的用力肺活量下降。对于尽管免疫抑制但疾病进展的患者，特别是具有 UIP 模式的患者，可以考虑启动抗纤维化治疗。未来的研究方向包括开发工具来预测哪些患者将保持稳定，哪些患者将出现进展，区分将对治疗有反应的患者与无反应的患者，以及开发启动免疫抑制、抗纤维化或两者作为一线治疗的算法。