1
|
Johnson SR, Bernstein EJ, Bolster MB, Chung JH, Danoff SK, George MD, Khanna D, Guyatt G, Mirza RD, Aggarwal R, Allen A, Assassi S, Buckley L, Chami HA, Corwin DS, Dellaripa PF, Domsic RT, Doyle TJ, Falardeau CM, Frech TM, Gibbons FK, Hinchcliff M, Johnson C, Kanne JP, Kim JS, Lim SY, Matson S, McMahan ZH, Merck SJ, Nesbitt K, Scholand MB, Shapiro L, Sharkey CD, Summer R, Varga J, Warrier A, Agarwal SK, Antin-Ozerkis D, Bemiss B, Chowdhary V, Dematte D'Amico JE, Hallowell R, Hinze AM, Injean PA, Jiwrajka N, Joerns EK, Lee JS, Makol A, McDermott GC, Natalini JG, Oldham JM, Saygin D, Lakin KS, Singh N, Solomon JJ, Sparks JA, Turgunbaev M, Vaseer S, Turner A, Uhl S, Ivlev I. 2023 American College of Rheumatology (ACR)/American College of Chest Physicians (CHEST) Guideline for the Treatment of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Diseases. Arthritis Care Res (Hoboken) 2024; 76:1051-1069. [PMID: 38973731 DOI: 10.1002/acr.25348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/18/2024] [Accepted: 04/09/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE We provide evidence-based recommendations regarding the treatment of interstitial lung disease (ILD) in adults with systemic autoimmune rheumatic diseases (SARDs). METHODS We developed clinically relevant population, intervention, comparator, and outcomes questions. A systematic literature review was then performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology. A panel of clinicians and patients reached consensus on the direction and strength of the recommendations. RESULTS Thirty-five recommendations were generated (including two strong recommendations) for first-line SARD-ILD treatment, treatment of SARD-ILD progression despite first-line ILD therapy, and treatment of rapidly progressive ILD. The strong recommendations were against using glucocorticoids in systemic sclerosis-ILD as a first-line ILD therapy and after ILD progression. Otherwise, glucocorticoids are conditionally recommended for first-line ILD treatment in all other SARDs. CONCLUSION This clinical practice guideline presents the first recommendations endorsed by the American College of Rheumatology and American College of Chest Physicians for the treatment of ILD in people with SARDs.
Collapse
Affiliation(s)
- Sindhu R Johnson
- University of Toronto, Schroeder Arthritis Institute, Toronto Western Hospital, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Elana J Bernstein
- Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York City
| | | | | | - Sonye K Danoff
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | | | | | | | | | - Hassan A Chami
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | | | - Tracy M Frech
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - Jeffrey P Kanne
- University of Wisconsin School of Medicine and Public Health, Madison
| | - John S Kim
- University of Virginia School of Medicine, Charlottesville
| | | | - Scott Matson
- University of Kansas Medical Center, Kansas City
| | | | | | | | | | | | | | - Ross Summer
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Didem Saygin
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | - Amy Turner
- American College of Rheumatology, Atlanta, Georgia
| | - Stacey Uhl
- Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania
| | - Ilya Ivlev
- Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania
| |
Collapse
|
2
|
Johnson SR, Bernstein EJ, Bolster MB, Chung JH, Danoff SK, George MD, Khanna D, Guyatt G, Mirza RD, Aggarwal R, Allen A, Assassi S, Buckley L, Chami HA, Corwin DS, Dellaripa PF, Domsic RT, Doyle TJ, Falardeau CM, Frech TM, Gibbons FK, Hinchcliff M, Johnson C, Kanne JP, Kim JS, Lim SY, Matson S, McMahan ZH, Merck SJ, Nesbitt K, Scholand MB, Shapiro L, Sharkey CD, Summer R, Varga J, Warrier A, Agarwal SK, Antin-Ozerkis D, Bemiss B, Chowdhary V, Dematte D'Amico JE, Hallowell R, Hinze AM, Injean PA, Jiwrajka N, Joerns EK, Lee JS, Makol A, McDermott GC, Natalini JG, Oldham JM, Saygin D, Lakin KS, Singh N, Solomon JJ, Sparks JA, Turgunbaev M, Vaseer S, Turner A, Uhl S, Ivlev I. 2023 American College of Rheumatology (ACR)/American College of Chest Physicians (CHEST) Guideline for the Treatment of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Diseases. Arthritis Rheumatol 2024; 76:1182-1200. [PMID: 38978310 DOI: 10.1002/art.42861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/18/2024] [Accepted: 04/09/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVE We provide evidence-based recommendations regarding the treatment of interstitial lung disease (ILD) in adults with systemic autoimmune rheumatic diseases (SARDs). METHODS We developed clinically relevant population, intervention, comparator, and outcomes questions. A systematic literature review was then performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology. A panel of clinicians and patients reached consensus on the direction and strength of the recommendations. RESULTS Thirty-five recommendations were generated (including two strong recommendations) for first-line SARD-ILD treatment, treatment of SARD-ILD progression despite first-line ILD therapy, and treatment of rapidly progressive ILD. The strong recommendations were against using glucocorticoids in systemic sclerosis-ILD as a first-line ILD therapy and after ILD progression. Otherwise, glucocorticoids are conditionally recommended for first-line ILD treatment in all other SARDs. CONCLUSION This clinical practice guideline presents the first recommendations endorsed by the American College of Rheumatology and American College of Chest Physicians for the treatment of ILD in people with SARDs.
Collapse
Affiliation(s)
- Sindhu R Johnson
- University of Toronto, Schroeder Arthritis Institute, Toronto Western Hospital, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Elana J Bernstein
- Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York City
| | | | | | - Sonye K Danoff
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | | | | | | | | | - Hassan A Chami
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | | | - Tracy M Frech
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - Jeffrey P Kanne
- University of Wisconsin School of Medicine and Public Health, Madison
| | - John S Kim
- University of Virginia School of Medicine, Charlottesville
| | | | - Scott Matson
- University of Kansas Medical Center, Kansas City
| | | | | | | | | | | | | | - Ross Summer
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Didem Saygin
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | - Amy Turner
- American College of Rheumatology, Atlanta, Georgia
| | - Stacey Uhl
- Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania
| | - Ilya Ivlev
- Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania
| |
Collapse
|
3
|
Motamedi M, Ferrara G, Yacyshyn E, Osman M, Abril A, Rahman S, Netchiporouk E, Gniadecki R. Skin disorders and interstitial lung disease: Part I-Screening, diagnosis, and therapeutic principles. J Am Acad Dermatol 2023; 88:751-764. [PMID: 36228941 DOI: 10.1016/j.jaad.2022.10.001] [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: 06/20/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022]
Abstract
Numerous inflammatory, neoplastic, and genetic skin disorders are associated with interstitial lung disease (ILD), the fibrosing inflammation of lung parenchyma that has significant morbidity and mortality. Therefore, the dermatologist plays a major role in the early detection and appropriate referral of patients at risk for ILD. Part 1 of this 2-part CME outlines the pathophysiology of ILD and focuses on clinical screening and therapeutic principles applicable to dermatological patients who are at risk for ILD. Patients with clinical symptoms of ILD should be screened with pulmonary function tests and high-resolution chest computed tomography. Screening for pulmonary hypertension should be considered in high-risk patients. Early identification and elimination of pulmonary risk factors, including smoking and gastroesophageal reflux disease, are essential in improving respiratory outcomes. First-line treatment interventions for ILD in a dermatological setting include mycophenolate mofetil, but the choice of therapeutic agents depends on the nature of the primary disease, the severity of ILD, and comorbidities and should be the result of a multidisciplinary assessment. Better awareness of ILD among medical dermatologists and close interdisciplinary collaborations are likely to prevent treatment delays improving long-term outcomes.
Collapse
Affiliation(s)
- Melika Motamedi
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
| | - Giovanni Ferrara
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Elaine Yacyshyn
- Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
| | - Mohammed Osman
- Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
| | - Andy Abril
- Division of Rheumatology, Mayo Clinic, Jacksonville, Florida
| | - Samia Rahman
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Robert Gniadecki
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
4
|
Hoffmann-Vold AM, Maher TM, Philpot EE, Ashrafzadeh A, Distler O. Assessment of recent evidence for the management of patients with systemic sclerosis-associated interstitial lung disease: a systematic review. ERJ Open Res 2021; 7:00235-2020. [PMID: 33644224 PMCID: PMC7897846 DOI: 10.1183/23120541.00235-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022] Open
Abstract
This systematic review summarises current evidence to help guide treatment decisions for patients with systemic sclerosis (SSc)-associated interstitial lung disease (ILD). A systematic search of the literature (January 2012 to April 2018), including grey literature (searched between 1992 and 2011), was conducted using multiple electronic databases. Guidelines, meta-analyses, randomised controlled trials and observational studies reporting on risk stratification, screening, diagnosis, treatment and management outcomes for patients with SSc-ILD were included. A quality assessment of the included evidence was undertaken. In total, 2464 publications were identified and 280 included. Multiple independent risk factors for ILD in patients with SSc were identified, including older age, male sex and baseline pulmonary function. High-resolution computed tomography (HRCT) has been used for characterising ILD in patients with SSc, and pulmonary function tests are a key adjunctive component in the diagnostic and monitoring pathway. The clinical value of biomarkers relating to SSc-ILD diagnosis or assessment for disease progression is unknown at present. Immunosuppressive therapy (monotherapy or combined therapy) is the current standard of care for SSc-ILD; long-term evidence for effective and safe treatment of SSc-ILD is limited. Identification of patients at risk for SSc-ILD remains challenging. HRCT and pulmonary function tests are key to diagnosing and monitoring for disease progression. Although immunosuppressive therapy is considered current first-line treatment, it is partly associated with adverse effects and long-term follow-up evidence is limited. Novel therapies and biomarkers should be further explored in well-controlled clinical studies.
Collapse
Affiliation(s)
- Anna-Maria Hoffmann-Vold
- Dept of Rheumatology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
- These authors contributed equally
| | - Toby M. Maher
- National Institute of Health Research Respiratory Clinical Research Facility, Royal Brompton Hospital, London, UK
- Fibrosis Research Group, National Heart and Lung Institute, Imperial College London, London, UK
- These authors contributed equally
| | | | - Ali Ashrafzadeh
- Rheumatology Center of Excellence, IQVIA, San Diego, CA, USA
| | - Oliver Distler
- Dept of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
5
|
Iudici M. What should clinicians know about the use of glucocorticoids in systemic sclerosis? Mod Rheumatol 2017; 27:919-923. [DOI: 10.1080/14397595.2016.1270796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Michele Iudici
- Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| |
Collapse
|
6
|
Yasuoka H. Recent Treatments of Interstitial Lung Disease with Systemic Sclerosis. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2016; 9:97-110. [PMID: 26819563 PMCID: PMC4720185 DOI: 10.4137/ccrpm.s23315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/15/2015] [Accepted: 09/23/2015] [Indexed: 02/06/2023]
Abstract
Systemic sclerosis (SSc) is a disorder characterized by immune dysfunction, microvascular injury, and fibrosis. Organ involvement in patients with SSc is variable; however, pulmonary involvement occurs in up to 90% of patients with SSc. Interstitial lung disease (ILD) is a major cause of mortality and, thus, a major determinant in the prognosis of patients with SSc. This review summarizes current findings about the characteristics of ILD in patients with SSc, selection of patients with SSc-ILD who are candidates for the treatment, and current treatment options.
Collapse
Affiliation(s)
- Hidekata Yasuoka
- Assistant Professor, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| |
Collapse
|
7
|
Huang H, Fava A, Guhr T, Cimbro R, Rosen A, Boin F, Ellis H. A methodology for exploring biomarker--phenotype associations: application to flow cytometry data and systemic sclerosis clinical manifestations. BMC Bioinformatics 2015; 16:293. [PMID: 26373409 PMCID: PMC4571079 DOI: 10.1186/s12859-015-0722-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/26/2015] [Indexed: 01/19/2023] Open
Abstract
Background This work seeks to develop a methodology for identifying reliable biomarkers of disease activity, progression and outcome through the identification of significant associations between high-throughput flow cytometry (FC) data and interstitial lung disease (ILD) - a systemic sclerosis (SSc, or scleroderma) clinical phenotype which is the leading cause of morbidity and mortality in SSc. A specific aim of the work involves developing a clinically useful screening tool that could yield accurate assessments of disease state such as the risk or presence of SSc-ILD, the activity of lung involvement and the likelihood to respond to therapeutic intervention. Ultimately this instrument could facilitate a refined stratification of SSc patients into clinically relevant subsets at the time of diagnosis and subsequently during the course of the disease and thus help in preventing bad outcomes from disease progression or unnecessary treatment side effects. The methods utilized in the work involve: (1) clinical and peripheral blood flow cytometry data (Immune Response In Scleroderma, IRIS) from consented patients followed at the Johns Hopkins Scleroderma Center. (2) machine learning (Conditional Random Forests - CRF) coupled with Gene Set Enrichment Analysis (GSEA) to identify subsets of FC variables that are highly effective in classifying ILD patients; and (3) stochastic simulation to design, train and validate ILD risk screening tools. Results Our hybrid analysis approach (CRF-GSEA) proved successful in predicting SSc patient ILD status with a high degree of success (>82 % correct classification in validation; 79 patients in the training data set, 40 patients in the validation data set). Conclusions IRIS flow cytometry data provides useful information in assessing the ILD status of SSc patients. Our new approach combining Conditional Random Forests and Gene Set Enrichment Analysis was successful in identifying a subset of flow cytometry variables to create a screening tool that proved effective in correctly identifying ILD patients in the training and validation data sets. From a somewhat broader perspective, the identification of subsets of flow cytometry variables that exhibit coordinated movement (i.e., multi-variable up or down regulation) may lead to insights into possible effector pathways and thereby improve the state of knowledge of systemic sclerosis pathogenesis. Electronic supplementary material The online version of this article (doi:10.1186/s12859-015-0722-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Hongtai Huang
- Department of Geography and Environmental Engineering, GWC Whiting School of Engineering, The Johns Hopkins University, Baltimore, MD, USA.
| | - Andrea Fava
- Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Tara Guhr
- Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Raffaello Cimbro
- Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Antony Rosen
- Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Francesco Boin
- Division of Rheumatology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Present address: Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA, USA.
| | - Hugh Ellis
- Department of Geography and Environmental Engineering, GWC Whiting School of Engineering, The Johns Hopkins University, Baltimore, MD, USA.
| |
Collapse
|
8
|
Redd D, Frech TM, Murtaugh MA, Rhiannon J, Zeng QT. Informatics can identify systemic sclerosis (SSc) patients at risk for scleroderma renal crisis. Comput Biol Med 2014; 53:203-5. [PMID: 25168254 DOI: 10.1016/j.compbiomed.2014.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 07/01/2014] [Accepted: 07/29/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Electronic medical records (EMR) provide an ideal opportunity for the detection, diagnosis, and management of systemic sclerosis (SSc) patients within the Veterans Health Administration (VHA). The objective of this project was to use informatics to identify potential SSc patients in the VHA that were on prednisone, in order to inform an outreach project to prevent scleroderma renal crisis (SRC). METHODS The electronic medical data for this study came from Veterans Informatics and Computing Infrastructure (VINCI). For natural language processing (NLP) analysis, a set of retrieval criteria was developed for documents expected to have a high correlation to SSc. The two annotators reviewed the ratings to assemble a single adjudicated set of ratings, from which a support vector machine (SVM) based document classifier was trained. Any patient having at least one document positively classified for SSc was considered positive for SSc and the use of prednisone≥10mg in the clinical document was reviewed to determine whether it was an active medication on the prescription list. RESULTS In the VHA, there were 4272 patients that have a diagnosis of SSc determined by the presence of an ICD-9 code. From these patients, 1118 patients (21%) had the use of prednisone≥10mg. Of these patients, 26 had a concurrent diagnosis of hypertension, thus these patients should not be on prednisone. By the use of natural language processing (NLP) an additional 16,522 patients were identified as possible SSc, highlighting that cases of SSc in the VHA may exist that are unidentified by ICD-9. A 10-fold cross validation of the classifier resulted in a precision (positive predictive value) of 0.814, recall (sensitivity) of 0.973, and f-measure of 0.873. CONCLUSIONS Our study demonstrated that current clinical practice in the VHA includes the potentially dangerous use of prednisone for veterans with SSc. This present study also suggests there may be many undetected cases of SSc and NLP can successfully identify these patients.
Collapse
Affiliation(s)
- Doug Redd
- Veterans Affair Medical Center Salt Lake City Health Care System, Salt Lake City, Utah, USA; Department of Internal Medicine, Division of Rheumatology, University of Utah School of Medicine and Veterans Affair Medical Center, Sat Lake City, Utah, USA; Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Tracy M Frech
- Veterans Affair Medical Center Salt Lake City Health Care System, Salt Lake City, Utah, USA; Department of Internal Medicine, Division of Rheumatology, University of Utah School of Medicine and Veterans Affair Medical Center, Sat Lake City, Utah, USA.
| | - Maureen A Murtaugh
- Veterans Affair Medical Center Salt Lake City Health Care System, Salt Lake City, Utah, USA; Department of Internal Medicine, Division of Rheumatology, University of Utah School of Medicine and Veterans Affair Medical Center, Sat Lake City, Utah, USA
| | - Julia Rhiannon
- Veterans Affair Medical Center Denver Health Care System, Denver, Colorado, USA
| | - Qing T Zeng
- Veterans Affair Medical Center Salt Lake City Health Care System, Salt Lake City, Utah, USA; Department of Internal Medicine, Division of Rheumatology, University of Utah School of Medicine and Veterans Affair Medical Center, Sat Lake City, Utah, USA; Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| |
Collapse
|
9
|
Iudici M, Fasano S, Iacono D, Russo B, Cuomo G, Valentini G. Prevalence and factors associated with glucocorticoids (GC) use in systemic sclerosis (SSc): a systematic review and meta-analysis of cohort studies and registries. Clin Rheumatol 2013; 33:153-64. [DOI: 10.1007/s10067-013-2422-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 10/18/2013] [Indexed: 11/30/2022]
|