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Mismetti V, Si-Mohamed S, Cottin V. Interstitial Lung Disease Associated with Systemic Sclerosis. Semin Respir Crit Care Med 2024; 45:342-364. [PMID: 38714203 DOI: 10.1055/s-0044-1786698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
Systemic sclerosis (SSc) is a rare autoimmune disease characterized by a tripod combining vasculopathy, fibrosis, and immune-mediated inflammatory processes. The prevalence of interstitial lung disease (ILD) in SSc varies according to the methods used to detect it, ranging from 25 to 95%. The fibrotic and vascular pulmonary manifestations of SSc, particularly ILD, are the main causes of morbidity and mortality, contributing to 35% of deaths. Although early trials were conducted with cyclophosphamide, more recent randomized controlled trials have been performed to assess the efficacy and tolerability of several medications, mostly mycophenolate, rituximab, tocilizumab, and nintedanib. Although many uncertainties remain, expert consensus is emerging to optimize the therapeutic management and to provide clinicians with evidence-based clinical practice guidelines for patients with SSc-ILD. This article provides an overview, in the light of the latest advances, of the available evidence for the diagnosis and management of SSc-ILD.
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Affiliation(s)
- Valentine Mismetti
- Department of Respiratory Medicine, National Coordinating Reference Centre for Rare Pulmonary Diseases, ERN-LUNG, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Salim Si-Mohamed
- INSA-Lyon, University of Lyon, University Claude-Bernard Lyon 1, Lyon, France
- Radiology Department, Hospices Civils de Lyon, Lyon, France
| | - Vincent Cottin
- Department of Respiratory Medicine, National Coordinating Reference Centre for Rare Pulmonary Diseases, ERN-LUNG, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
- UMR 754, INRAE, Claude Bernard University Lyon 1, Lyon, France
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2
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Mercier C, Thoreau B, Flament T, Legué S, Pearson A, Jobard S, Marchand-Adam S, Plantier L, Diot E. High Prevalence of the Lung Ultrasound Interstitial Syndrome in Systemic Sclerosis Patients with Normal HRCT and Lung Function-A Pilot Study. J Clin Med 2024; 13:2885. [PMID: 38792426 PMCID: PMC11121911 DOI: 10.3390/jcm13102885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/24/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Objective: High-resolution computed tomography (HRCT) may lack sensitivity for the early detection of interstitial lung disease associated with systemic sclerosis (SSc-ILD). Lung ultrasound is an emerging technique for the diagnosis of SSc-ILD. This cross-sectional study aimed to describe the prevalence of ultrasound interstitial syndrome in SSc patients with normal HRCT and pulmonary function tests (PFT). Methods: Thirty SSc patients with normal HRCT, FVC > 80% predicted and DLCO > 70% predicted were included. Echocardiography and PFT including impulse oscillometry and cardiopulmonary exercise testing were performed. Lung ultrasound was analyzed by two blinded operators. Patients were classified into two groups, according to the presence or absence of ultrasound interstitial syndrome, defined as the sum of B-lines in all thoracic areas ≥10 and/or pleural line thickness >3 mm on at least one thoracic area and/or a pleural line irregularity score >16%. Results: Ultrasound interstitial syndrome was present in 12 patients (40%). Inter-reader agreement for the diagnosis of ultrasound interstitial syndrome defined by the Kappa coefficient was 0.93 (95%CI 0.79-1.00). Patients with ultrasound interstitial syndrome were younger (37 years vs. 53 years, p = 0.009), more often had pitting scars (n = 7/12 vs. 3/18, p = 0.045) and had lower FVC (102 vs. 110% pred, p = 0.009), TLC (114 vs. 122% pred, p = 0.042) and low-frequency respiratory system reactance (Xrs5 Z-score 0.16 vs. 1.02, p = 0.018), while pulmonary gas exchange was similar. Conclusions: Ultrasound interstitial syndrome was detected in 12/30 SSc patients with normal HRCT and PFT. Patients with ultrasound interstitial syndrome had differences in lung function consistent with reduced respiratory compliance, suggesting minimal and/or early suspected SSc-ILD.
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Affiliation(s)
- Camille Mercier
- Service de Médecine Interne et Immunologie Clinique, Centre de Compétence Maladies Systémiques Auto-Immunes Rares, CHRU Tours, 37000 Tours, France; (S.J.); (E.D.)
| | - Benjamin Thoreau
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Auto-Immunes Rares d’Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), 75610 Paris, France;
- Institut Cochin, Inserm U1016, CNRS UMR 8104, Université Paris Cité, 75006 Paris, France
| | - Thomas Flament
- Service de Pneumologie et Explorations Fonctionnelles Respiratoires, Centre de Référence Maladies Pulmonaires Rares, CHRU Tours, 37000 Tours, France; (T.F.); (S.L.); (S.M.-A.); (L.P.)
- Lung Ultrasound Working Group (G-ECHO), Société de Pneumologie de Langue Française, Île-de-France, 75935 Paris, France
| | - Sylvie Legué
- Service de Pneumologie et Explorations Fonctionnelles Respiratoires, Centre de Référence Maladies Pulmonaires Rares, CHRU Tours, 37000 Tours, France; (T.F.); (S.L.); (S.M.-A.); (L.P.)
- Lung Ultrasound Working Group (G-ECHO), Société de Pneumologie de Langue Française, Île-de-France, 75935 Paris, France
| | | | - Stephanie Jobard
- Service de Médecine Interne et Immunologie Clinique, Centre de Compétence Maladies Systémiques Auto-Immunes Rares, CHRU Tours, 37000 Tours, France; (S.J.); (E.D.)
| | - Sylvain Marchand-Adam
- Service de Pneumologie et Explorations Fonctionnelles Respiratoires, Centre de Référence Maladies Pulmonaires Rares, CHRU Tours, 37000 Tours, France; (T.F.); (S.L.); (S.M.-A.); (L.P.)
- Centre d’Etudes des Pathologies Respiratoires (CEPR), Institut National de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR) 1100, Université de Tours, 37032 Tours, France
| | - Laurent Plantier
- Service de Pneumologie et Explorations Fonctionnelles Respiratoires, Centre de Référence Maladies Pulmonaires Rares, CHRU Tours, 37000 Tours, France; (T.F.); (S.L.); (S.M.-A.); (L.P.)
- Centre d’Etudes des Pathologies Respiratoires (CEPR), Institut National de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR) 1100, Université de Tours, 37032 Tours, France
| | - Elisabeth Diot
- Service de Médecine Interne et Immunologie Clinique, Centre de Compétence Maladies Systémiques Auto-Immunes Rares, CHRU Tours, 37000 Tours, France; (S.J.); (E.D.)
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3
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Freire M, Sopeña B, González-Quintela A, Del Castillo AG, Moraga EC, Lledó-Ibañez GM, Rubio-Rivas M, Trapiella L, Argibay A, Tolosa C, Alfonso BM, Vargas-Hitos JA, Salas XP, González-Echávarri C, Chamorro AJ, Fraile IP, García AG, de la Red Bellvis G, Bello DB, Salomó AC, Jiménez Pérez de Heredia I, Marín-Ballve A, Rodríguez-Pintó I, Saez-Comet L, Ortego-Centeno N, Todolí-Parra JA, Fonollosa Pla V, Simeón-Aznar CP. Exposure to different occupational chemicals and clinical phenotype of a cohort of patients with systemic sclerosis. Autoimmun Rev 2024; 23:103542. [PMID: 38599508 DOI: 10.1016/j.autrev.2024.103542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 04/07/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Mayka Freire
- Unit of Systemic Diseases, Department of Internal Medicine, Hospital Clínico Universitario de Santiago de Compostela, A Coruña, Spain.
| | - Bernardo Sopeña
- Unit of Systemic Diseases, Department of Internal Medicine, Hospital Clínico Universitario de Santiago de Compostela, A Coruña, Spain
| | - Arturo González-Quintela
- Unit of Systemic Diseases, Department of Internal Medicine, Hospital Clínico Universitario de Santiago de Compostela, A Coruña, Spain
| | - Alfredo Guillén Del Castillo
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Eduardo Callejas Moraga
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Gema M Lledó-Ibañez
- Department of Autoimmune Diseases. Reference Centre for Systemic Autoimmune Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems-Member of ERNReCONNET, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Manuel Rubio-Rivas
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Luis Trapiella
- Department of Internal Medicine, Hospital de Cabueñes, Gijón, Spain
| | - Ana Argibay
- Unit of Systemic Diseases, Department of Internal Medicine, Complejo Hospitalario Universitario de Vigo, Spain
| | - Carles Tolosa
- Department of Internal Medicine, Corporación Sanitaria Universitaria Parc Taulí, Sabadell, Barcelona, Spain
| | - Begoña Marí Alfonso
- Department of Internal Medicine, Corporación Sanitaria Universitaria Parc Taulí, Sabadell, Barcelona, Spain
| | | | - Xavier Pla Salas
- Unit of Systemic Autoimmune Diseases, Department of Internal Medicine, Consorci Hospitalari de Vic, Barcelona, Spain
| | - Cristina González-Echávarri
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Hospital Universitario de Cruces, Baracaldo, Spain
| | - Antonio-J Chamorro
- Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca, Spain
| | - Isabel Perales Fraile
- Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain
| | | | | | - David Bernal Bello
- Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Antoni Castro Salomó
- Department of Internal Medicine, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | | | - Adela Marín-Ballve
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
| | - Ignasi Rodríguez-Pintó
- Department of Internal Medicine, Hospital Universitario Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Luis Saez-Comet
- Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Norberto Ortego-Centeno
- Inst Invest Biosanitaria Ibs Granada. Department of Internal Medicine, Unit of Systemic Autoimmune Diseases. Department of Medicine, Facultad de Medicina, Hospital Universitario San Cecilio, Granada, Spain
| | | | - Vicent Fonollosa Pla
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Carmen Pilar Simeón-Aznar
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Smith DJF, Jenkins RG. Contemporary Concise Review 2022: Interstitial lung disease. Respirology 2023; 28:627-635. [PMID: 37121779 DOI: 10.1111/resp.14511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 05/02/2023]
Abstract
Novel genetic associations for idiopathic pulmonary fibrosis (IPF) risk have been identified. Common genetic variants associated with IPF are also associated with chronic hypersensitivity pneumonitis. The characterization of underlying mechanisms, such as pathways involved in myofibroblast differentiation, may reveal targets for future treatments. Newly identified circulating biomarkers are associated with disease progression and mortality. Deep learning and machine learning may increase accuracy in the interpretation of CT scans. Novel treatments have shown benefit in phase 2 clinical trials. Hospitalization with COVID-19 is associated with residual lung abnormalities in a substantial number of patients. Inequalities exist in delivering and accessing interstitial lung disease specialist care.
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Affiliation(s)
- David J F Smith
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Interstitial Lung Disease, Royal Brompton and Harefield Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - R Gisli Jenkins
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Interstitial Lung Disease, Royal Brompton and Harefield Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
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Volkmann ER, Tashkin DP, Silver R, Bostwick CF, Assassi S, Frost DB, Leng M, Wilhalme H, Kim GH, Goldin J, Roth MD. Sex differences in clinical outcomes and biological profiles in systemic sclerosis-associated interstitial lung disease: a post-hoc analysis of two randomised controlled trials. THE LANCET. RHEUMATOLOGY 2022; 4:e668-e678. [PMID: 37745675 PMCID: PMC10518185 DOI: 10.1016/s2665-9913(22)00193-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Background Observational studies have shown that men with systemic sclerosis have an increased risk of interstitial lung disease (ILD) and mortality compared with women. However, previous studies have not controlled for treatment effect or evaluated the biological mechanism or mechanisms underlying this sex difference. We aimed to compare ILD progression and long-term morbidity and mortality outcomes in male and female participants of two randomised controlled trials for systemic sclerosis-associated ILD. Methods For this post-hoc analysis, data from all participants in the Scleroderma Lung Study (SLS) I and SLS II were analysed. The primary objective was to explore the effect of sex on the course of the percentage predicted forced vital capacity (FVC) during and after active treatment over the 24-month study periods. In SLS I, 158 participants (111 women, 47 men) were randomly assigned to receive oral cyclophosphamide (cyclophosphamide; ≤2 mg/kg daily) or placebo; in SLS II, 142 participants (105 women, 37 men) were randomly assigned to receive oral mycophenolate mofetil (1500 mg twice daily) or oral cyclophosphamide (≤2 mg/kg daily). Sex (ie, male or female) was self-reported in both studies by the participants. Changes in radiographic fibrosis and time to death and respiratory failure were secondary outcomes of the present analysis. Baseline levels of biomarkers implicated in the pathobiology of systemic sclerosis-associated ILD were measured in bronchoalveolar lavage fluid in SLS I. Findings In the SLS I placebo group, the rate of decline in percentage predicted FVC from 3 months to 12 months was greater in men than in women, but the difference was not significant (estimated effect -0·29 [95% CI -0·67 to 0·10]; p=0·14). In SLS II, the rate of decline in percentage predicted FVC from 3 months to 12 months was significantly worse in men treated with either cyclophosphamide (estimated effect -0·72; [95% CI -1·14 to -0·31]; p=0·00060) or mycophenolate mofetil (estimated effect -0·34 [-0·58 to -0·10]; p=0·0051) than in women. A greater proportion of men had a decline in percentage predicted FVC of 10% or greater compared with women for the pooled active treatment groups from SLS I and SLS II and the placebo group of SLS I. Men had worse radiographic outcomes at 2 years than women in SLS II, even after adjusting for baseline disease severity and treatment arm assignment. Long-term survival was worse in men in SLS I (log-rank test p=0·080) and SLS II (log-rank test p=0·030). In SLS II, male sex was independently associated with increased mortality (hazard ratio 2·42 [95% CI 1·16 to 5·04]; p=0·018). In bronchoalveolar lavage fluid, men had increased concentrations of pro-fibrotic mediators (eg, matrix metalloproteinase-13 and tissue inhibitor of metallopeptidase 1), whereas women had increased pro-inflammatory mediators (eg, interleukin [IL]-12, IL-7, and granulocyte-colony stimulating factor). Interpretation In two randomised controlled trials, men with systemic sclerosis-associated ILD had a less favourable course of ILD both with and without active treatment, as well as worse long-term survival. Sex differences in pro-fibrotic or inflammatory mediators of disease might account for these differences and warrant future study. Funding US National Institutes of Health; US National Heart, Lung, and Blood Institute; US National Institute of Arthritis and Musculoskeletal and Skin Diseases; Bristol Myers Squibb; and Hoffmann-LaRoche.
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Affiliation(s)
- Elizabeth R Volkmann
- (E R Volkmann MD MS, Prof D P Tashkin MD, M Leng MD, H Wilhalme MS, Prof M D Roth MD) (G H Kim PhD, Prof J Goldin MD PhD), (Prof R Silver MD, Prof C F Bostwick PhD, D Baker Frost MD PhD); (Prof S Assassi MD MS)
| | - Donald P Tashkin
- (E R Volkmann MD MS, Prof D P Tashkin MD, M Leng MD, H Wilhalme MS, Prof M D Roth MD) (G H Kim PhD, Prof J Goldin MD PhD), (Prof R Silver MD, Prof C F Bostwick PhD, D Baker Frost MD PhD); (Prof S Assassi MD MS)
| | - Richard Silver
- (E R Volkmann MD MS, Prof D P Tashkin MD, M Leng MD, H Wilhalme MS, Prof M D Roth MD) (G H Kim PhD, Prof J Goldin MD PhD), (Prof R Silver MD, Prof C F Bostwick PhD, D Baker Frost MD PhD); (Prof S Assassi MD MS)
| | - Carol Feghali Bostwick
- (E R Volkmann MD MS, Prof D P Tashkin MD, M Leng MD, H Wilhalme MS, Prof M D Roth MD) (G H Kim PhD, Prof J Goldin MD PhD), (Prof R Silver MD, Prof C F Bostwick PhD, D Baker Frost MD PhD); (Prof S Assassi MD MS)
| | - Shervin Assassi
- (E R Volkmann MD MS, Prof D P Tashkin MD, M Leng MD, H Wilhalme MS, Prof M D Roth MD) (G H Kim PhD, Prof J Goldin MD PhD), (Prof R Silver MD, Prof C F Bostwick PhD, D Baker Frost MD PhD); (Prof S Assassi MD MS)
| | - DeAnna Baker Frost
- (E R Volkmann MD MS, Prof D P Tashkin MD, M Leng MD, H Wilhalme MS, Prof M D Roth MD) (G H Kim PhD, Prof J Goldin MD PhD), (Prof R Silver MD, Prof C F Bostwick PhD, D Baker Frost MD PhD); (Prof S Assassi MD MS)
| | - Mei Leng
- (E R Volkmann MD MS, Prof D P Tashkin MD, M Leng MD, H Wilhalme MS, Prof M D Roth MD) (G H Kim PhD, Prof J Goldin MD PhD), (Prof R Silver MD, Prof C F Bostwick PhD, D Baker Frost MD PhD); (Prof S Assassi MD MS)
| | - Holly Wilhalme
- (E R Volkmann MD MS, Prof D P Tashkin MD, M Leng MD, H Wilhalme MS, Prof M D Roth MD) (G H Kim PhD, Prof J Goldin MD PhD), (Prof R Silver MD, Prof C F Bostwick PhD, D Baker Frost MD PhD); (Prof S Assassi MD MS)
| | - Grace Hyun Kim
- (E R Volkmann MD MS, Prof D P Tashkin MD, M Leng MD, H Wilhalme MS, Prof M D Roth MD) (G H Kim PhD, Prof J Goldin MD PhD), (Prof R Silver MD, Prof C F Bostwick PhD, D Baker Frost MD PhD); (Prof S Assassi MD MS)
| | - Jonathan Goldin
- (E R Volkmann MD MS, Prof D P Tashkin MD, M Leng MD, H Wilhalme MS, Prof M D Roth MD) (G H Kim PhD, Prof J Goldin MD PhD), (Prof R Silver MD, Prof C F Bostwick PhD, D Baker Frost MD PhD); (Prof S Assassi MD MS)
| | - Michael D Roth
- (E R Volkmann MD MS, Prof D P Tashkin MD, M Leng MD, H Wilhalme MS, Prof M D Roth MD) (G H Kim PhD, Prof J Goldin MD PhD), (Prof R Silver MD, Prof C F Bostwick PhD, D Baker Frost MD PhD); (Prof S Assassi MD MS)
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Volkmann ER. Occupational Exposures and Systemic Sclerosis-Related Lung Disease. Chest 2022; 161:874-875. [DOI: 10.1016/j.chest.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 11/26/2022] Open
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