Aryeh Fischer, MD, Editor

Paul F. Dellaripa, MD, Editor

There is a myriad of pulmonary manifestations, with varied incidence and prevalence, associated with the rheumatic diseases; essentially every component of the respiratory tract is at risk of injury in these patients. Furthermore, despite the remarkable advances over the past decades in managing rheumatic diseases, lung disease continues to be associated with significant morbidity and is a leading cause of mortality in patients with rheumatic disease. It is not known why some rheumatic diseases are more likely to be associated with certain types of lung involvement, and there is much to learn about the natural history and treatment of lung involvement among these cohorts.

For the clinician, the evaluation of the rheumatic disease patient with cough or dyspnea and diffusely abnormal chest imaging is always a challenge. The clinical context, pulmonary physiology data, the patterns visualized on thoracic high-resolution computerized tomographic scanning, and the histopathologic findings on lung biopsy specimens all play a critical role in the search for the diagnosis. We start with a practical and thorough overview of the radiologist’s approach to lung disease in rheumatic disease patients followed by a comprehensive review of the pulmonary histopathologic patterns identified in these cohorts. Moving beyond imaging and pathology, with hopes of providing a map for this clinical maze and highlighting the importance of each piece of information and where it fits—the approach to determining respiratory impairment in those with rheumatic diseases is provided. The subsequent articles review the specific rheumatic diseases and their associated forms of lung disease. Specifically, the lung manifestations of rheumatoid arthritis, systemic sclerosis, poly-/dermatomyositis, systemic lupus erythematosus, mixed connective tissue disease, and Sjögren syndrome are comprehensively discussed. A practical approach to the comprehensive management of interstitial lung disease in patients with rheumatic diseases is then provided. The final two articles provide an up-to-date and thorough review of pulmonary hypertension associated with rheumatic diseases and pulmonary vasculitis.

We recognize the outstanding combined efforts of the authors of this thematic issue for Rheumatic Disease Clinics of North America and hope this volume serves to further your understanding of the complex intersection of lung disease in rheumatic diseases and proves to be a useful resource that enhances your care of these patients.