Accepted for/Published in: JMIR Research Protocols
Date Submitted: Feb 27, 2025
Date Accepted: Jun 20, 2025
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Protocol for the Systematic Review and Meta-Analysis
ABSTRACT
Background:
Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD) is a significant extra-articular manifestation of rheumatoid arthritis (RA), characterized by progressive lung fibrosis and inflammation, leading to increased morbidity and mortality. While anti-inflammatory therapies have traditionally been used to manage RA-ILD, emerging evidence suggests that antifibrotic therapies may also offer clinical benefits. This protocol outlines a systematic review and meta-analysis to compare the safety and efficacy of antifibrotic versus anti-inflammatory therapies in the management of chronic RA-ILD.
Objective:
This study aims to evaluate and compare the impact of antifibrotic and anti-inflammatory therapies on lung function, radiologic progression, clinical outcomes, and safety in patients with chronic RA-ILD.
Methods:
A systematic search will be conducted across PubMed, Embase, and the Cochrane Library, following PRISMA guidelines. Eligible studies will include adult patients (≥18 years) diagnosed with RA-ILD and treated with either antifibrotic or anti-inflammatory therapies. Primary outcomes include pulmonary function parameters—forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and diffusing capacity of the lungs for carbon monoxide (DLCO). Secondary outcomes include radiological changes (e.g., fibrosis progression on high-resolution computed tomography), clinical endpoints (e.g., disease progression rates, overall survival, quality of life), and safety and tolerability of therapies. Pooled effect estimates will be calculated using random-effects meta-analysis, and heterogeneity will be assessed via Cochran’s Q test and I² statistic.
Results:
This systematic review will identify the comparative efficacy and safety profiles of antifibrotic and anti-inflammatory therapies, providing valuable insights for clinicians managing chronic RA-ILD.
Conclusions:
The findings will address critical gaps in the management of RA-ILD, offering evidence-based recommendations for therapeutic decision-making and improving outcomes for patients with this debilitating condition. Clinical Trial: The study protocol has been registered with PROSPERO (CRD42024583847). Registration Link: https://www.crd.york.ac.uk/prospero/export_details_pdf.php
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