{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T14:04:54Z","timestamp":1790949894604,"version":"4.1.0"},"reference-count":68,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2023,10,20]],"date-time":"2023-10-20T00:00:00Z","timestamp":1697760000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Rheumatoid arthritis (RA) is a chronic autoimmune multisystem inflammatory disease in which lung involvement is the most common extra-articular manifestation. Parenchymal lung involvement or interstitial lung disease (ILD) is a significant cause of morbidity and mortality and there is a paucity of evidence-based guidance on how to best treat RA-ILD. This review article aims to evaluate the evidence from cohort studies and best real word data from registries. Extensive discussion of the relative merits and drawbacks of glucocorticoids, various biologics, small molecules and anti-fibrotics is presented. The limited available guidelines in RA-ILD are also discussed and a rational treatment algorithm is offered.<\/jats:p>","DOI":"10.3390\/jcm12206657","type":"journal-article","created":{"date-parts":[[2023,10,20]],"date-time":"2023-10-20T11:53:56Z","timestamp":1697802836000},"page":"6657","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Targeted Therapy in Rheumatoid-Arthritis-Related Interstitial Lung Disease"],"prefix":"10.3390","volume":"12","author":[{"given":"Robert","family":"Harrington","sequence":"first","affiliation":[{"name":"St. James\u2019s Hospital, LS9 7TF Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Harkins","sequence":"additional","affiliation":[{"name":"St. James\u2019s Hospital, LS9 7TF Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2538-3362","authenticated-orcid":false,"given":"Richard","family":"Conway","sequence":"additional","affiliation":[{"name":"St. James\u2019s Hospital, LS9 7TF Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2023","DOI":"10.1016\/S0140-6736(16)30173-8","article-title":"Rheumatoid Arthritis","volume":"388","author":"Smolen","year":"2016","journal-title":"Lancet"},{"key":"ref_2","first-page":"209","article-title":"Cause of death in autopsied RA patients","volume":"33","author":"Toyoshima","year":"1993","journal-title":"Ryumachi"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1002\/art.27405","article-title":"Incidence and mortality of interstitial lung disease in rheumatoid arthritis: A population-based study","volume":"62","author":"Bongartz","year":"2010","journal-title":"Arthritis Rheum."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1097\/BOR.0000000000000270","article-title":"Management of connective tissue diseases associated interstitial lung disease: A review of the published literature","volume":"28","author":"Wallace","year":"2016","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Kiely, P., Busby, A.D., Nikiphorou, E., Sullivan, K., A Walsh, D., Creamer, P., Dixey, J., and Young, A. (2019). Is incident rheumatoid arthritis interstitial lung disease associated with methotrexate treatment? Results from a multivariate analysis in the ERAS and ERAN inception cohorts. BMJ Open, 9.","DOI":"10.1136\/bmjopen-2018-028466"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"837133","DOI":"10.3389\/fmed.2022.837133","article-title":"Interstitial Lung Disease in Rheumatoid Arthritis: A Practical Review","volume":"9","author":"Laria","year":"2022","journal-title":"Front. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1097\/BOR.0000000000000238","article-title":"The lung in rheumatoid arthritis, cause or consequence?","volume":"28","author":"Chatzidionisyou","year":"2016","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1148\/radiology.205.1.9314990","article-title":"Diffuse lung disease: Diagnostic accuracy of CT in patients undergoing surgical biopsy of the lung","volume":"205","author":"Swensen","year":"1997","journal-title":"Radiology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1183\/09031936.00092309","article-title":"Usual interstitial pneumonia in rheumatoid arthritis-associated interstitial lung disease","volume":"35","author":"Kim","year":"2010","journal-title":"Eur. Respir. J."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Nurmi, H.M., Purokivi, M.K., Karkkainen, M.S., Kettunen, A.P., Selander, T.A., and Kaarteenaho, R.L. (2016). Variable course of disease of rheumatoid arthritis associated usual interstitial pneumonia compared to other subtypes. BMC Pulm. Med., 16.","DOI":"10.1186\/s12890-016-0269-2"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"60","DOI":"10.3109\/s10165-007-0004-1","article-title":"A simultaneous onset of organizing pneumonia and rheumatoid arthritis, along with a review of the literature","volume":"18","author":"Mori","year":"2008","journal-title":"Mod. Rheumatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"v1","DOI":"10.1136\/thx.2008.101691","article-title":"Interstitial lung disease guideline: The British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society","volume":"63","author":"Bradley","year":"2008","journal-title":"Thorax"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1136\/annrheumdis-2014-eular.1247","article-title":"Association between steroid therapy and survival in patients with rheumatoid arthritis interstitial lung disease","volume":"73","author":"Scott","year":"2014","journal-title":"Ann. Rheum. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"The Idiopathic Pulmonary Fibrosis Clinical Research Network (2014). Randomized trial of acetylcysteine in idiopathic pulmonary fibrosis. N. Engl. J. Med., 370, 2093\u20132101.","DOI":"10.1056\/NEJMoa1401739"},{"key":"ref_15","first-page":"103","article-title":"Clinical course and outcome of rheumatoid arthritis-related usual interstitial pneumonia","volume":"30","author":"Song","year":"2013","journal-title":"Sarcoidosis Vasc. Diffus. Lung Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1002\/art.1780261015","article-title":"Acute lung disease associated with low-dose pulse methotrexate therapy in patients with rheumatoid arthritis","volume":"26","author":"Cannon","year":"1983","journal-title":"Arthritis Rheum."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2000337","DOI":"10.1183\/13993003.00337-2020","article-title":"Methotrexate and rheumatoid arthritis associated interstitial lung disease","volume":"57","author":"Juge","year":"2021","journal-title":"Eur. Respir. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1007\/s10067-017-3707-5","article-title":"Rheumatoid arthritis-related interstitial lung disease (RAILD): Methotrexate and the severity of lung disease are associated to prognosis","volume":"36","author":"MateosToledo","year":"2017","journal-title":"Clin. Rheumatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1002\/art.38322","article-title":"Methotrexate and lung disease in rheumatoid arthritis: A meta-analysis of randomized controlled trials","volume":"66","author":"Conway","year":"2014","journal-title":"Arthritis Rheumatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"369","DOI":"10.7326\/M19-3369","article-title":"Adverse Effects of Low-Dose Methotrexate: A Randomized Trial","volume":"172","author":"Solomon","year":"2020","journal-title":"Ann. Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1136\/ard.2009.120626","article-title":"Influence of anti-TNF therapy on mortality in patients with rheumatoid arthritis-associated interstitial lung disease: Results from the British Society for Rheumatology Biologics Register","volume":"69","author":"Dixon","year":"2010","journal-title":"Ann. Rheum. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Druce, K.L., Iqbal, K., Watson, K.D., Symmons, D.P.M., Hyrich, K.L., and Kelly, C. (2017). Mortality in patients with interstitial lung disease treated with rituximab or TNFi as a first biologic. RMD Open, 3.","DOI":"10.1136\/rmdopen-2017-000473"},{"key":"ref_23","first-page":"S573","article-title":"The incidence of exacerbation of pre-existing interstitial lung disease (ILD) is higher in TNF blockers than in non-TNF blockers in RA","volume":"62","author":"Nakashita","year":"2012","journal-title":"Arthritis Rheumatol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Nakashita, T., Ando, K., Kaneko, N., Takahashi, K., and Motojima, S. (2014). Potential risk of TNF inhibitors on the progression of interstitial lung disease in patients with rheumatoid arthritis. BMJ Open, 4.","DOI":"10.1136\/bmjopen-2014-005615"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1093\/rheumatology\/kex072","article-title":"Effect of rituximab on the progression of rheumatoid arthritis-related interstitial lung disease: 10 years\u2019 experience at a single centre","volume":"56","author":"Kabia","year":"2017","journal-title":"Rheumatology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2099","DOI":"10.1093\/rheumatology\/kez673","article-title":"Efficacy of rituximab in slowing down progression of rheumatoid arthritis-related interstitial lung disease: Data from the NEREA Registry","volume":"59","author":"Vadillo","year":"2020","journal-title":"Rheumatology"},{"key":"ref_27","first-page":"1","article-title":"Rituximab for rheumatoid arthritis-related interstitial lung disease: A systematic review and meta-analysis","volume":"38","author":"Boppana","year":"2023","journal-title":"Arch. Rheumatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/j.resinv.2016.03.001","article-title":"Possible effect of abatacept on the progression of interstitial lung disease in rheumatoid arthritis patients","volume":"54","author":"Nakashita","year":"2016","journal-title":"Respir. Investig."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1080\/14397595.2018.1481566","article-title":"Longterm deterioration of interstitial lung disease in patients with rheumatoid arthritis treated with abatacept","volume":"29","author":"Mochizuki","year":"2019","journal-title":"Mod. Rheumatol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Cassone, G., Manfredi, A., Atzeni, F., Venerito, V., Vacchi, C., Picerno, V., Furini, F., Erre, G.L., Tomietto, P., and Fedele, A.L. (2020). Safety of abatacept in Italian patients with rheumatoid arthritis and interstitial lung disease: A multicenter retrospective study. J. Clin. Med., 9.","DOI":"10.3390\/jcm9010277"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"3906","DOI":"10.1093\/rheumatology\/keaa621","article-title":"Abatacept in interstitial lung disease associated with rheumatoid arthritis: National multicenter study of 263 patients","volume":"59","year":"2020","journal-title":"Rheumatology"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Atienza-Mateo, B., Fern\u00e1ndez-D\u00edaz, C., Vicente-Rabaneda, E.F., Melero-Gonz\u00e1lez, R.B., Ortiz-Sanju\u00e1n, F., Casafont-Sol\u00e9, I., Rodr\u00edguez-Garc\u00eda, S.C., Ferraz-Amaro, I., Casta\u00f1eda, S., and Blanco, R. (2023). Abatacept in usual and in non-specific interstitial pneumonia associated with rheumatoid arthritis. Eur. J. Intern. Med., S0953-6205(23)00309-6.","DOI":"10.1016\/j.ejim.2023.08.025"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1186\/s13075-015-0835-7","article-title":"Incidence and complications of interstitial lung disease in users of tocilizumab, rituximab, abatacept and anti-tumor necrosis factor alpha agents, a retrospective cohort study","volume":"17","author":"Curtis","year":"2015","journal-title":"Arthritis Res. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"15","DOI":"10.3899\/jrheum.130466","article-title":"Effectiveness and safety of tocilizumab: Post marketing surveillance of 7901 patients with rheumatoid arthritis in Japan","volume":"41","author":"Koike","year":"2014","journal-title":"J. Rheumatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1111\/resp.13419_192","article-title":"Effect of tocilizumab on interstitial lung disease in patients with rheumatoid arthritis","volume":"23","author":"Otsuji","year":"2018","journal-title":"Respirology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1007\/s10787-022-00936-w","article-title":"A retrospective study of the efficacy of JAK inhibitors or abatacept on rheumatoid arthritis-interstitial lung disease","volume":"30","author":"Tardella","year":"2022","journal-title":"Inflammopharmacology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1007\/s00296-021-04835-1","article-title":"A retrospective comparison of respiratory events with JAK inhibitors or rituximab for rheumatoid arthritis in patients with pulmonary disease","volume":"41","author":"Cronin","year":"2021","journal-title":"Rheumatol. Int."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"106748","DOI":"10.1016\/j.intimp.2020.106748","article-title":"Efficacy of baricitinib in treating rheumatoid arthritis: Modulatory effects on fibrotic and inflammatory biomarkers in a real-life setting","volume":"86","author":"Perillo","year":"2020","journal-title":"Int. Immunopharmacol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Baker, M.C., Liu, Y., Lu, R., Lin, J., Melehani, J., and Robinson, W.H. (2023). Incidence of Interstitial Lung Disease in Patients with Rheumatoid Arthritis Treated with Biologic and Targeted Synthetic Disease-Modifying Antirheumatic Drugs. JAMA Netw. Open, 6.","DOI":"10.1001\/jamanetworkopen.2023.3640"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1016\/S2213-2600(16)30152-7","article-title":"Mycophenolate mofetil versus oral cyclophosphamide in scleroderma-related interstitial lung disease (SLS II): A randomised controlled, double-blind, parallel group trial","volume":"4","author":"Tashkin","year":"2016","journal-title":"Lancet Respir. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1097\/MAJ.0b013e31818d094b","article-title":"Experience of mycophenolate mofetil in 10 patients with autoimmune-related interstitial lung disease demonstrates promising effects","volume":"337","author":"Saketkoo","year":"2009","journal-title":"Am. J. Med. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"640","DOI":"10.3899\/jrheum.121043","article-title":"Mycophenolate mofetil improves lung function in connective tissue disease-associated interstitial lung disease","volume":"40","author":"Fischer","year":"2013","journal-title":"J. Rheumatol."},{"key":"ref_43","first-page":"i99","article-title":"The effect of steroids, azathioprine and mycophenolate on the risk of death in rheumatoid arthritis","volume":"55","author":"Kelly","year":"2016","journal-title":"Rheumatology"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"P117","DOI":"10.1016\/j.rmed.2016.11.007","article-title":"Azathioprine response in patients with fibrotic connective tissue disease-associated interstitial lung disease","volume":"121","author":"Oldham","year":"2016","journal-title":"Respir. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2071","DOI":"10.1056\/NEJMoa1402584","article-title":"Efficacy and safety of nintedanib in idiopathic pulmonary fibrosis","volume":"370","author":"Richeldi","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1136\/annrheumdis-2020-eular.3211","article-title":"Effect of nintedanib on progression of interstitial lung disease (ILD) in patients with autoimmune disease-related ILDs: Further data from the INBUILD trial","volume":"79","author":"Matteson","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1136\/annrheumdis-2020-eular.3668","article-title":"Efficacy and safety of nintedanib in patients with autoimmune disease-related interstitial lung disease treated with DMARDs and\/or glucocorticoids at baseline","volume":"79","author":"Aringer","year":"2020","journal-title":"Ann. Rheum. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"3279","DOI":"10.1007\/s12325-019-01086-2","article-title":"The design and rationale of the Trail1 trial: A randomized double-blind phase 2 clinical trial of pirfenidone in rheumatoid arthritis-associated interstitial lung disease","volume":"36","author":"Solomon","year":"2019","journal-title":"Adv. Ther."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Solomon, J., Woodhead, F., Danoff, S., Haynes-Harp, S., Naik, T., Spino, C., Hurwitz, S., Maurer, R., Chambers, D., and Kolb, M. (2023, September 27). A Randomized Double-Blinded Placebo-Controlled Phase 2 Study of Safety Tolerability and Efficacy of Pirfenidone in Patients with Rheumatoid Arthritis Interstitial Lung Disease (Abstract). Available online: https:\/\/acrabstracts.org\/abstract\/a-randomized-double-blinded-placebo-controlled-phase-2-study-of-safety-tolerability-and-efficacy-of-pirfenidone-in-patients-with-rheumatoid-arthritis.","DOI":"10.1016\/j.chest.2021.12.293"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1183\/09059180.00001111","article-title":"Antifibrotic activities of pirfenidone in animal models","volume":"20","author":"Schaefer","year":"2011","journal-title":"Eur. Respir. Rev."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"105700","DOI":"10.1016\/j.intimp.2019.105700","article-title":"Inhibitory effects of pirfenidone on fibroblast to myofibroblast transition in rheumatoid arthritis-associated interstitial lung disease via the downregulation of activating transcription factor 3 (ATF3)","volume":"74","author":"Wu","year":"2019","journal-title":"Int. Immunopharmacol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2487","DOI":"10.1056\/NEJMra032588","article-title":"Pneumocystis pneumonia","volume":"350","author":"Thomas","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1002\/1529-0131(199904)42:4<780::AID-ANR23>3.0.CO;2-M","article-title":"Pneumocystis carinii pneumonia in patients with connective tissue diseases: The role of hospital experience in diagnosis and mortality","volume":"42","author":"Ward","year":"1999","journal-title":"Arthritis Rheum."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Ishikawa, Y., Nakano, K., Tokutsu, K., Miyata, H., Fujino, Y., Matsuda, S., and Tanaka, Y. (2021). Estimation of treatment and prognostic factors of pneumocystis pneumonia in patients with connective tissue disease. RMD Open, 7.","DOI":"10.1136\/rmdopen-2020-001508"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1136\/ard.2007.072967","article-title":"Postmarketing surveillance of the safety profile of infliximab in 5000 Japanese patients with rheumatoid arthritis","volume":"67","author":"Takeuchi","year":"2008","journal-title":"Ann. Rheum. Dis."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"343","DOI":"10.3109\/s10165-010-0406-3","article-title":"Post-marketing surveillance of safety and effectiveness of etanercept in Japanese patients with rheumatoid arthritis","volume":"21","author":"Koike","year":"2011","journal-title":"Mod. Rheumatol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2148","DOI":"10.1136\/ard.2011.151092","article-title":"Post-marketing surveillance of tocilizumab for rheumatoid arthritis in Japan: Interim analysis of 3881 patients","volume":"70","author":"Koike","year":"2011","journal-title":"Ann. Rheum. Dis."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"491","DOI":"10.3109\/14397595.2015.1123211","article-title":"Post-marketing surveillance of the safety and effectiveness of abatacept in Japanese patients with rheumatoid arthritis","volume":"26","author":"Harigai","year":"2016","journal-title":"Mod. Rheumatol."},{"key":"ref_59","first-page":"1200","article-title":"AB0431 Post-marketing surveillance of tofacitinib in Japanese patients with rheumatoid arthritis: An interim report of safety data","volume":"76","author":"Mimori","year":"2017","journal-title":"Ann. Rheum. Dis."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1093\/rheumatology\/keq314","article-title":"Pneumocystis jirovecii colonization in patients with systemic autoimmune diseases: Prevalence, risk factors of colonization and outcome","volume":"50","author":"Mekinian","year":"2010","journal-title":"Rheumatology"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"208","DOI":"10.3109\/03009742.2011.630328","article-title":"High prevalence of Pneumocystis jirovecii colonization among patients with autoimmune inflammatory diseases and corticosteroid therapy","volume":"41","author":"Fritzsche","year":"2012","journal-title":"Scand. J. Rheumatol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1111\/j.1365-2362.2010.02415.x","article-title":"Pneumocystis jirovecii colonization in patients treated with infliximab","volume":"41","author":"Wissmann","year":"2011","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_63","first-page":"29","article-title":"Pneumocystis jirovecii Pneumonia in Rheumatoid Arthritis Patients: Risks and Prophylaxis Recommendations","volume":"9","author":"Mori","year":"2015","journal-title":"Clin. Med. Insights Circ. Respir. Pulm. Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"R43","DOI":"10.1186\/ar4472","article-title":"Prophylaxis for Pneumocystis pneumonia in patients with rheumatoid arthritis treated with biologics, based on risk factors found in a retrospective study","volume":"16","author":"Katsuyama","year":"2014","journal-title":"Arthritis Res. Ther."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1093\/rheumatology\/keh071","article-title":"Detection of Pneumocystis carinii by DNA amplification in patients with connective tissue diseases: Re-evaluation of clinical features of P carinii pneumonia in rheumatic diseases","volume":"43","author":"Saito","year":"2004","journal-title":"Rheumatology"},{"key":"ref_66","first-page":"246","article-title":"Pneumocystis carinii pneumonia in the course of connective tissue disease: Report of 34 cases","volume":"21","author":"Godeau","year":"1994","journal-title":"J. Rheumatol."},{"key":"ref_67","unstructured":"(2023, September 20). 2023 American College of Rheumatology (ACR) Guideline for the Treatment of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Disease Guideline Summary. Available online: https:\/\/assets.contentstack.io\/v3\/assets\/bltee37abb6b278ab2c\/bltaedebda97a351d47\/interstitial-lung-disease-guideline-summary-treatment-2023.pdf."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.reuma.2022.03.005","article-title":"Recomendaciones SER-SEPAR para el manejo de la enfermedad pulmonar intersticial difusa asociada a la artritis reumatoide. Parte 2: Tratamiento","volume":"18","author":"Bonilla","year":"2022","journal-title":"Reumatol. Clin."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/20\/6657\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:09:18Z","timestamp":1760130558000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/20\/6657"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,20]]},"references-count":68,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["jcm12206657"],"URL":"https:\/\/doi.org\/10.3390\/jcm12206657","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,20]]}}}