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Rheumatoid arthritis (RA) is an immune-mediated rheumatic disease (IMRDs) characterized by chronic erosive arthritis and systemic damage to internal organs, leading to early disability and reduced life expectancy in patients. A particularly important place among the systemic manifestations of RA is occupied by interstitial lung diseases (ILD) – the most severe form of pulmonary pathology in RA, defined as RA-ILD, which is pathogenetically associated with risk factors (smoking, etc.) and autoimmune mechanisms underlying RA. RA-ILD is a subtype of RA characterized by a severe course and a poor prognosis. The review presents new data regarding risk factors and biomarkers for RA-ILD; modern diagnostic capabilities based on the use of functional lung tests, high-resolution computed tomography, ultrasound examination of the lungs. Particular attention is paid to the efficacy and safety of pharmacotherapy, including methotrexate, biologics, JAK inhibitors, and antifibrotic therapy. An algorithm for the pharmacotherapy of RA-ILD has been proposed.

The possibilities of treatment of patients with metastatic non-small cell lung cancer have significantly expanded in the recent years. Several combined regimens of chemoimmunotherapy are currently being proposed as the first line, some patients with PD-L1 overexpression may be prescribed pembrolizumab or atezolizumab in monotherapy. Standard platinum-containing chemotherapy (PCT) has lost its position and is relevant only for contraindications to immuno-oncological (IO) drugs. The change in the standart of the first line inevitably led to the search for new optimal modes of the second line. The strategy of "angio-immunogenic switching" is promising after progression on the regimens with IO, anti-angiogenic drugs are used. Nintedanib a multikinase angiogenesis inhibitor in combination with docetaxel is a standard second-line therapy option in patients with lung adenocarcinoma after progression on PCT. The effectiveness of this regimen is being studied in a prospective non-interventional VARGADO study. The patients were divided into 3 cohorts, depending on which regimen was used earlier one line of PCT or PCT, followed by IO or chemoimmunotherapy. The results showed that the combination of docetaxel + nintedanib was effective both as a third line (after PCT and IO), and in the second after chemoimmunotherapy. The research is ongoing.

The problem of fibrosing interstitial lung diseases (ILDs) unites specialists from different areas: pulmonologists, radiologists, therapists, rheumatologists, occupational doctors and others. Actual achievements in studying fibrosing ILDs which are connected with development of immunology and molecular biological methods for the determination of biomarkers, new principles of image-diagnostics of lung pathology, search of new therapeutic “targets”, dictate the necessity of integration of knowledge by specialists from different areas of medicine for improvement pharmacotherapy algorithms. These algorithms directed to decrease fibrosis progression in ILDs, improve quality and increase lifespan of the patients.

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Interstitial lung diseases (ILDs) are a heterogenous group of disorders and pathological conditions of known and unknown nature characterized by extensive and, generally, bilateral damage of the respiratory part of the lungs (alveoli, respiratory bronchioles). Until recently, there weren’t any effective therapies for patients with progressive pulmonary fibrosis, partly because of limited knowledge of the disease pathogenesis. However, in the last decade, new data of etiological, genetic factors and pathogenetic mechanisms of ILD were obtained. Currently, only two drugs were proven effective for treatment of patients with interstitial pulmonary fibrosis: pirfenidone and nintedanib which affect the rate of progression of restrictive changes in the lungs. The search for drugs is continuing in accordance with the growing understanding of pathogenetic mechanisms of ILDs. Notably, recent years saw an “explosion” of pre-clinical studies.

This review reviews the efficacy and safety of therapy with tyrosine kinase inhibitors and pyrphenidone in idiopathic pulmonary fibrosis. The results of randomized trials of recent years are described in detail. The efficacy of taking tyrosine kinase inhibitors at the following key research points is considered: the annual rate of decrease in vital capacity of the lung, a 6-minute walk test, the quality of life of the patient, and the frequency of exacerbations. Systematic literature search was carried out on the databases Scopus, Web of Science, MedLine, elibrary and others.

Rheumatoid arthritis (RA) is an immune-mediated rheumatic disease (IMRDs) characterized by chronic erosive arthritis and systemic damage to internal organs, leading to early disability and reduced life expectancy in patients. A particularly important place among the systemic manifestations of RA is occupied by interstitial lung diseases (ILD) – the most severe form of pulmonary pathology in RA, defined as RA-ILD, which is pathogenetically associated with risk factors (smoking, etc.) and autoimmune mechanisms underlying RA. RA-ILD is a subtype of RA characterized by a severe course and a poor prognosis и неблагоприятным прогнозом. The review presents new data regarding risk factors and biomarkers for RA-ILD; modern diagnostic capabilities based on the use of functional lung tests, high-resolution computed tomography, ultrasound examination of the lungs. Particular attention is paid to the efficacy and safety of pharmacotherapy, including methotrexate, biologics, JAK inhibitors, and antifibrotic therapy. An algorithm for the pharmacotherapy of RA-ILD has been proposed.