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Boleto G, Reiseter S, Hoffmann-Vold AM, Mirouse A, Cacoub P, Matucci-Cerinic M, Silvério-António M, Fonseca JE, Duarte AC, Pestana Lopes J, Riccieri V, Lescoat A, Le Tallec E, Castellví Barranco I, Tandaipan JL, Airó P, Kuwana M, Kavosi H, Avouac J, Allanore Y. The phenotype of mixed connective tissue disease patients having associated interstitial lung disease. Semin Arthritis Rheum 2023; 63:152258. [PMID: 37696231 DOI: 10.1016/j.semarthrit.2023.152258] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/17/2023] [Accepted: 08/15/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE We aimed to compare two matched populations of patients with MTCD with and without associated ILD and to identify predictive factors for ILD progression and severity. METHODS This international multicenter retrospective study (14 tertiary hospitals), included MCTD patients who fulfilled at least one historical MCTD classification criteria. ILD was defined by the presence of typical chest high-resolution computed tomography (HRCT) abnormalities. Factors associated with ILD were assessed at baseline. Long-term progressive ILD was assessed in MCTD-ILD patients with multiple forced vital capacity (FVC) measurements. RESULTS 300 patients with MCTD were included. Mean age at diagnosis was 39.7 ± 15.4 years and 191 (63.7%) were women. Mean follow-up was 7.8 ± 5.5 years. At baseline, we identified several factors associated with ILD presence: older age (p = 0.01), skin thickening (p = 0.03), upper gastro-intestinal (GI) symptoms (p<0.001), FVC <80% (p<0.0001), diffusing capacity for carbon monoxide <80% (p<0.0001), anti-topoisomerase antibodies (p = 0.01), SSA/Ro antibodies (p = 0.02), cryoglobulinemia (p = 0.04) and elevated C-reactive protein (p<0.001). Patients with MTCD-ILD were more likely to be treated with synthetic immunosuppressant agents (p<0.001) in particular mycophenolate mofetil (p = 0.03). Digital ulcers (DU) were identified as a risk factor for FVC decline >10%. During follow-up mortality was higher in the MTCD-ILD group (p<0.001). CONCLUSION In this large international cohort of patients with MTCD, we identified different factors associated with ILD. Our findings also provide evidence that MCTD-ILD patients have increased mortality and that DU are associated with progressive lung disease.
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Affiliation(s)
- Gonçalo Boleto
- Department of Rheumatology, Université Paris Cité, Cochin Hospital, Paris, France; Instituto Português de Reumatologia, Lisboa, Portugal
| | - Silje Reiseter
- Department of Rheumatology, Martina Hansen Hospital, Sandvika, Norway
| | | | - Adrien Mirouse
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris F-75013, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris F-75013, France
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UNIRAR), Irccs San Raffaele Hospital, Milan, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Manuel Silvério-António
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal
| | - Joao Eurico Fonseca
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Universitário Lisboa Norte and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa (CAML), Lisbon, Portugal
| | | | | | - Valeria Riccieri
- Department of Clinical, Internal, Anaesthesiologic, Cardiologic Sciences, University of Rome Sapienza, Rome, Italy
| | - Alain Lescoat
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - Erwan Le Tallec
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - Ivan Castellví Barranco
- Department of Rheumatology and Systemic Autoimmune Diseases, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jose Luis Tandaipan
- Department of Rheumatology and Systemic Autoimmune Diseases, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Paolo Airó
- Rheumatology and Clinical Immunology Unit, Spedali Civili, Brescia, Italy
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Hoda Kavosi
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Kargar Avenue, 14117-13137, Tehran, Iran
| | - Jérôme Avouac
- Department of Rheumatology, Université Paris Cité, Cochin Hospital, Paris, France; INSERM U1016, Institut Cochin, CNRS UMR8104, Paris, France
| | - Yannick Allanore
- Department of Rheumatology, Université Paris Cité, Cochin Hospital, Paris, France; INSERM U1016, Institut Cochin, CNRS UMR8104, Paris, France.
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Qin S, Jiao B, Kang B, Li H, Liu H, Ji C, Yang S, Yuan H, Wang X. Non-contrast computed tomography-based radiomics for staging of connective tissue disease-associated interstitial lung disease. Front Immunol 2023; 14:1213008. [PMID: 37868980 PMCID: PMC10587549 DOI: 10.3389/fimmu.2023.1213008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/15/2023] [Indexed: 10/24/2023] Open
Abstract
Rationale and introduction It is of significance to assess the severity and predict the mortality of patients with connective tissue disease-associated interstitial lung disease (CTD-ILD). In this double-center retrospective study, we developed and validated a radiomics nomogram for clinical management by using the ILD-GAP (gender, age, and pulmonary physiology) index system. Materials and methods Patients with CTD-ILD were staged using the ILD-GAP index system. A clinical factor model was built by demographics and CT features, and a radiomics signature was developed using radiomics features extracted from CT images. Combined with the radiomics signature and independent clinical factors, a radiomics nomogram was constructed and evaluated by the area under the curve (AUC) from receiver operating characteristic (ROC) analyses. The models were externally validated in dataset 2 to evaluate the model generalization ability using ROC analysis. Results A total of 245 patients from two clinical centers (dataset 1, n = 202; dataset 2, n = 43) were screened. Pack-years of smoking, traction bronchiectasis, and nine radiomics features were used to build the radiomics nomogram, which showed favorable calibration and discrimination in the training cohort {AUC, 0.887 [95% confidence interval (CI): 0.827-0.940]}, the internal validation cohort [AUC, 0.885 (95% CI: 0.816-0.922)], and the external validation cohort [AUC, 0.85 (95% CI: 0.720-0.919)]. Decision curve analysis demonstrated that the nomogram outperformed the clinical factor model and radiomics signature in terms of clinical usefulness. Conclusion The CT-based radiomics nomogram showed favorable efficacy in predicting individual ILD-GAP stages.
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Affiliation(s)
- Songnan Qin
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Bingxuan Jiao
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Bing Kang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Haiou Li
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Hongwu Liu
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Congshan Ji
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Shifeng Yang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Hongtao Yuan
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Qin S, Kang B, Liu H, Ji C, Li H, Zhang J, Wang X. A computed tomography-based radiomics nomogram for predicting overall survival in patients with connective tissue disease-associated interstitial lung disease. Eur J Radiol 2023; 165:110963. [PMID: 37437436 DOI: 10.1016/j.ejrad.2023.110963] [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: 04/19/2023] [Revised: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES Accurate prognostic prediction is beneficial for the management of patients with connective tissue disease-associated interstitial lung disease (CTD-ILD). The purpose of the present study was to develop and validate a nomogram using clinical features and computed tomography (CT) based radiomics features to predict overall survival (OS) in patients with CTD-ILD, and to assess the incremental prognostic value the radiomics might add to clinical risk factors. MATERIALS & METHODS Patients from two clinical centers with CTD-ILD were enrolled in the present retrospective study. A radiomics signature, a clinical model and a combined nomogram were developed and assessed in the cohorts. The incremental value of radiomics signature to the clinical independent risk factors in survival prediction was evaluated. The models were externally validated to evaluate the model generalization ability. RESULTS A total of 215 patients (mean age, 53 years ± 14 [standard deviation], 45 men) were evaluated. Patients with higher radiomics scores had higher mortality risk than those with lower radiomics scores (Hazard ratio, 12.396; 95% CI, 3.364-45.680; P < 0.001). The combined nomogram showed better predictive capability than the clinical model did with higher C-indices (0.800, 0.738, 0.742 vs. 0.747, 0.631, 0.587 in the training, internal- and external-validation cohort, respectively), time-AUCs and overall net-benefit. CONCLUSION The radiomics signature is a potential prognostic biomarker of CTD-ILD and add incremental value to the clinical independent risk factors. The combined nomogram can provide a more accurate estimation of OS than the clinical model for CTD-ILD patients. CLINICAL RELEVANCE STATEMENT The developed combined nomogram showed accurate prognostic prediction performance, which is beneficial for the management of CTD-ILD patients. It also proved radiomics could extract prognostic information from CT images.
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Affiliation(s)
- Songnan Qin
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan 250021, Shandong, China
| | - Bing Kang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324, Jing 5 Rd, Jinan 250021, Shandong, China
| | - Hongwu Liu
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324, Jing 5 Rd, Jinan 250021, Shandong, China
| | - Congshan Ji
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324, Jing 5 Rd, Jinan 250021, Shandong, China
| | - Haiou Li
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, China
| | - Juntao Zhang
- GE Healthcare, PDx GMS Advanced Analytics, Shanghai, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan 250021, Shandong, China; Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324, Jing 5 Rd, Jinan 250021, Shandong, China.
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Clinical and radiological features of lung disorders related to connective-tissue diseases: a pictorial essay. Insights Imaging 2022; 13:108. [PMID: 35767157 PMCID: PMC9243214 DOI: 10.1186/s13244-022-01243-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/28/2022] [Indexed: 11/10/2022] Open
Abstract
Connective tissue diseases (CTDs) include a spectrum of disorders that affect the connective tissue of the human body; they include autoimmune disorders characterized by immune-mediated chronic inflammation and the development of fibrosis. Lung involvement can be misdiagnosed, since pulmonary alterations preceded osteo-articular manifestations only in 20% of cases and they have no clear clinical findings in the early phases. All pulmonary structures may be interested: pulmonary interstitium, airways, pleura and respiratory muscles. Among these autoimmune disorders, rheumatoid arthritis (RA) is characterized by usual interstitial pneumonia (UIP), pulmonary nodules and airway disease with air-trapping, whereas non-specific interstitial pneumonia (NSIP), pulmonary hypertension and esophageal dilatation are frequently revealed in systemic sclerosis (SSc). NSIP and organizing pneumonia (OP) may be found in patients having polymyositis (PM) and dermatomyositis (DM); in some cases, perilobular consolidations and reverse halo-sign areas may be observed. Systemic lupus erythematosus (SLE) is characterized by serositis, acute lupus pneumonitis and alveolar hemorrhage. In the Sjögren syndrome (SS), the most frequent pattern encountered on HRCT images is represented by NSIP; UIP and lymphocytic interstitial pneumonia (LIP) are reported with a lower frequency. Finally, fibrotic NSIP may be the interstitial disease observed in patients having mixed connective tissue diseases (MCTD). This pictorial review therefore aims to provide clinical features and imaging findings associated with autoimmune CTDs, in order to help radiologists, pneumologists and rheumatologists in their diagnoses and management.
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Plantier L, Smolinska A, Fijten R, Flamant M, Dallinga J, Mercadier JJ, Pachen D, d'Ortho MP, van Schooten FJ, Crestani B, Boots AW. The use of exhaled air analysis in discriminating interstitial lung diseases: a pilot study. Respir Res 2022; 23:12. [PMID: 35057817 PMCID: PMC8772159 DOI: 10.1186/s12931-021-01923-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fibrotic Interstitial lung diseases (ILD) are a heterogeneous group of chronic lung diseases characterized by diverse degrees of lung inflammation and remodeling. They include idiopathic ILD such as idiopathic pulmonary fibrosis (IPF), and ILD secondary to chronic inflammatory diseases such as connective tissue disease (CTD). Precise differential diagnosis of ILD is critical since anti-inflammatory and immunosuppressive drugs, which are beneficial in inflammatory ILD, are detrimental in IPF. However, differential diagnosis of ILD is still difficult and often requires an invasive lung biopsy. The primary aim of this study is to identify volatile organic compounds (VOCs) patterns in exhaled air to non-invasively discriminate IPF and CTD-ILD. As secondary aim, the association between the IPF and CTD-ILD discriminating VOC patterns and functional impairment is investigated. METHODS Fifty-three IPF patients, 53 CTD-ILD patients and 51 controls donated exhaled air, which was analyzed for its VOC content using gas chromatograph- time of flight- mass spectrometry. RESULTS By applying multivariate analysis, a discriminative profile of 34 VOCs was observed to discriminate between IPF patients and healthy controls whereas 11 VOCs were able to distinguish between CTD-ILD patients and healthy controls. The separation between IPF and CTD-ILD could be made using 16 discriminating VOCs, that also displayed a significant correlation with total lung capacity and the 6 min' walk distance. CONCLUSIONS This study reports for the first time that specific VOC profiles can be found to differentiate IPF and CTD-ILD from both healthy controls and each other. Moreover, an ILD-specific VOC profile was strongly correlated with functional parameters. Future research applying larger cohorts of patients suffering from a larger variety of ILDs should confirm the potential use of breathomics to facilitate fast, non-invasive and proper differential diagnosis of specific ILDs in the future as first step towards personalized medicine for these complex diseases.
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Affiliation(s)
- L Plantier
- Department of Pulmonology and Lung Function Testing, CHRU, Tours, France
- Université de Tours, Tours, France
- Centre d'Etude des Pathologies Respiratoires, INSERM UMR1100, Tours, France
| | - A Smolinska
- Department of Pharmacology and Toxicology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - R Fijten
- Department of Pharmacology and Toxicology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Radiation Oncology (Maastro) GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, 6229 ET, Maastricht, The Netherlands
| | - M Flamant
- Service de Physiologie - Explorations Fonctionnelle, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
| | - J Dallinga
- Department of Pharmacology and Toxicology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - J J Mercadier
- Service de Physiologie - Explorations Fonctionnelle, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
| | - D Pachen
- Department of Pharmacology and Toxicology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - M P d'Ortho
- Service de Physiologie - Explorations Fonctionnelle, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
- Université de Paris, INSERM UMR 1141, NeuroDiderot, France
| | - F J van Schooten
- Department of Pharmacology and Toxicology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - B Crestani
- Service de Pneumologie A, DHU FIRE, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
- Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France
- INSERM UMR1152, Labex Inflamex, Paris, France
| | - A W Boots
- Department of Pharmacology and Toxicology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
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Shao T, Shi X, Yang S, Zhang W, Li X, Shu J, Alqalyoobi S, Zeki AA, Leung PS, Shuai Z. Interstitial Lung Disease in Connective Tissue Disease: A Common Lesion With Heterogeneous Mechanisms and Treatment Considerations. Front Immunol 2021; 12:684699. [PMID: 34163483 PMCID: PMC8215654 DOI: 10.3389/fimmu.2021.684699] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/17/2021] [Indexed: 01/11/2023] Open
Abstract
Connective tissue disease (CTD) related interstitial lung disease (CTD-ILD) is one of the leading causes of morbidity and mortality of CTD. Clinically, CTD-ILD is highly heterogenous and involves rheumatic immunity and multiple manifestations of respiratory complications affecting the airways, vessels, lung parenchyma, pleura, and respiratory muscles. The major pathological features of CTD are chronic inflammation of blood vessels and connective tissues, which can affect any organ leading to multi-system damage. The human lung is particularly vulnerable to such damage because anatomically it is abundant with collagen and blood vessels. The complex etiology of CTD-ILD includes genetic risks, epigenetic changes, and dysregulated immunity, which interact leading to disease under various ill-defined environmental triggers. CTD-ILD exhibits a broad spectra of clinical manifestations: from asymptomatic to severe dyspnea; from single-organ respiratory system involvement to multi-organ involvement. The disease course is also featured by remissions and relapses. It can range from stability or slow progression over several years to rapid deterioration. It can also present clinically as highly progressive from the initial onset of disease. Currently, the diagnosis of CTD-ILD is primarily based on distinct pathology subtype(s), imaging, as well as related CTD and autoantibodies profiles. Meticulous comprehensive clinical and laboratory assessment to improve the diagnostic process and management strategies are much needed. In this review, we focus on examining the pathogenesis of CTD-ILD with respect to genetics, environmental factors, and immunological factors. We also discuss the current state of knowledge and elaborate on the clinical characteristics of CTD-ILD, distinct pathohistological subtypes, imaging features, and related autoantibodies. Furthermore, we comment on the identification of high-risk patients and address how to stratify patients for precision medicine management approaches.
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Affiliation(s)
- Tihong Shao
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Division of Rheumatology/Allergy and Clinical Immunology, University of California, Davis, Davis, CA, United States
| | - Xiaodong Shi
- Rheumatology, First Hospital of Jilin University, Changchun, China
| | - Shanpeng Yang
- Department of Pharmacy, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Zhang
- Department of Pathology, The First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu, China
| | - Xiaohu Li
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jingwei Shu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Shehabaldin Alqalyoobi
- Internal Medicine - Pulmonary, Critical Care, and Sleep Medicine, Brody School of Medicine, Greenville, NC, United States
| | - Amir A. Zeki
- University of California (U.C.), Davis, Lung Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, U.C. Davis School of Medicine, University of California, Davis, Davis, CA, United States
| | - Patrick S. Leung
- Division of Rheumatology/Allergy and Clinical Immunology, University of California, Davis, Davis, CA, United States
| | - Zongwen Shuai
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Peredo RA, Mehta V, Beegle S. Interstitial Lung Disease Associated with Connective Tissue Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1304:73-94. [PMID: 34019264 DOI: 10.1007/978-3-030-68748-9_5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pulmonary manifestations of connective tissue diseases (CTD) carry high morbidity and potential mortality, and the most serious pulmonary type is interstitial lung disease (ILD). Identifying and promptly intervening CTD-ILD with immune suppressor therapy will change the natural course of the disease resulting in survival improvement. Compared to idiopathic pulmonary fibrosis, the most common presentation of idiopathic interstitial pneumonia (IIP), CTD-ILD carries a better prognosis due to the response to immune suppressor therapy. Nonspecific interstitial pneumonia (NSIP) is the most common type of CTD-ILD that is different from the fibrotic classical presentation of IPF, known as usual interstitial pneumonia (UIP). An exception is rheumatoid arthritis that presents more frequently with UIP type. Occasionally, IPF may not have typical radiographic features of UIP, and a full assessment to differentiate IPF from CTD-ILD is necessary, including the intervention of a multidisciplinary team and the histopathology. Interstitial pneumonia with autoimmune features (IPAF) shows promising advantages to identify patients with ILD who have some features of a CTD without a defined autoimmune disease and who may benefit from immune suppressors. A composition of clinical, serological, and morphologic features in patients presenting with ILD will fulfill criteria for IPAF. In summary, the early recognition and treatment of CTD-ILD, differentiation from IPF-UIP, and identification of patients with IPAF fulfill the assessment by the clinician for an optimal care.
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Affiliation(s)
- Ruben A Peredo
- Division of Rheumatology, Department of Medicine, Albany Medical College, Albany, NY, USA.
| | - Vivek Mehta
- Rheumatology, Alaska Native Medical Center, Anchorage, AK, USA
| | - Scott Beegle
- Division of Pulmonary & Critical Care Medicine, Albany Medical College, Albany, NY, USA
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Topcu A, Mursaloglu HH, Yalcinkaya Y, Karakurt S, Yagiz B, Alaca Z, Demir M, Coskun BN, Dalkilic E, Inanc N. Evaluation of rheumatoid arthritis and connective tissue disease-related interstitial lung disease with pulmonary physiologic test, HRCT, and patient-based measures of dyspnea and functional disability. Clin Rheumatol 2021; 40:3797-3805. [PMID: 33811590 DOI: 10.1007/s10067-021-05693-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 03/02/2021] [Accepted: 03/11/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES We aim to investigate the relationship between pulmonary function and imaging parameters with symptom-related patient-reported outcome measures (PROs). METHOD We included 65 patients of rheumatoid arthritis (RA) and connective tissue disease (CTD) with and without interstitial lung disease (ILD) into this cross-sectional study. We evaluated the relationship between FVC, DLco, and PROs and compared to HRCT findings. PROs included visual analogue scale for breathing, modified Borg scale, medical research council dyspnea scale, St. George's respiratory questionnaire (SGRQ), Leicester cough questionnaire, and Short Form 36 quality of life (SF-36 QoL). RESULTS The mean age was 57.4 ± 9.7 and 61.9% (39/65) of patients had an established ILD. In RA-ILD group, SGRQ score was higher (p < 0.001) and SF-36 physical functioning score was lower (p = 0.02) than CTD-ILD group. In RA group, there was a significant correlation between FVC and SF-36 role functioning/physical score (r = 0.724, p = 0.012). In CTD group, SF-36 general health score was correlated with both FVC (r = 0.441, p = 0.045) and DLco (r = 0.485, p = 0.035), and also SF-36 physical functioning score was correlated with FVC (r = 0.441, p = 0.040). PROs were found to be similar between ILD and non-ILD patients. SF-36 QoL total and SGRQ outcomes were worse in non-ILD group. CONCLUSIONS We concluded that PROs could be used to evaluate health-related quality of life (HRQoL) in RA- or CTD-related ILD. The physical health determinants of HRQoL are measurably worse in RA-ILD patients than in CTD patients. But, PROs may not be very helpful in differentiating patients with cough and/or shortness of breath due to ILD or non-ILD causes in RA/CTD. KEY POINTS • HRQoL may be affected differently among specific subtypes of ILD. • PROs can be used to evaluate dyspnea and function of patients with RA- or CTD-related ILD but are not distinguished from patients with cough and/or shortness of breath due to non-ILD causes in RA/CTD.
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Affiliation(s)
- Atakan Topcu
- Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Yasemin Yalcinkaya
- Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Sait Karakurt
- Department of Chest Diseases and Intensive Care, Marmara University School of Medicine, Istanbul, Turkey
| | - Burcu Yagiz
- Division of Rheumatology, Bursa Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Zeynep Alaca
- Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Meryem Demir
- Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Belkis Nihan Coskun
- Division of Rheumatology, Bursa Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Ediz Dalkilic
- Division of Rheumatology, Bursa Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Nevsun Inanc
- Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey.
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Kim HC, Song JS, Park S, Yoon HY, Lim SY, Chae EJ, Jang SJ, Song JW. Histologic features suggesting connective tissue disease in idiopathic pulmonary fibrosis. Sci Rep 2020; 10:21137. [PMID: 33273612 PMCID: PMC7713371 DOI: 10.1038/s41598-020-78140-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 11/18/2020] [Indexed: 11/09/2022] Open
Abstract
Some patients with idiopathic pulmonary fibrosis (IPF) have histopathologic features suggesting connective tissue disease (CTD); however, their clinical course and prognosis remain unclear. Thus, we aimed to investigate the clinical course and prognosis of these patients with histologic autoimmune features. Among 114 patients with biopsy-proven IPF, the histologic features were semi-quantitatively graded, and CTD scores (range: 0-9) were calculated as the sum of each score of plasma cell infiltration, lymphoid aggregates, and germinal centres. Patients with high CTD scores (≥ 4) were classified into the interstitial pneumonia with histologic autoimmune features (IP-hAF) group. The mean age of the patients was 60.0 years; 74.6% were men, 69.3% were ever-smokers, and 35.1% had IP-hAF. During follow-up, the IP-hAF group showed slower decline in lung function, and better prognosis (median survival, 48.7 vs. 40.4 months; p = 0.015) than the no-IP-hAF group. On multivariate Cox analysis, IP-hAF was an independent prognostic factor (hazard ratio, 0.522; p = 0.016), along with the lower diffusing capacity for carbon monoxide, higher scores of reticulation and honeycombing, and usual interstitial pneumonia pattern on high-resolution computed tomography. Patients with IPF having histologic autoimmune features show distinct clinical characteristics and better outcome than those without histologic autoimmune features.
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Affiliation(s)
- Ho Cheol Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Joon Seon Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sojung Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hee-Young Yoon
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - So Yun Lim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Jin Chae
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Se Jin Jang
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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10
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Jee AS, Sheehy R, Hopkins P, Corte TJ, Grainge C, Troy LK, Symons K, Spencer LM, Reynolds PN, Chapman S, de Boer S, Reddy T, Holland AE, Chambers DC, Glaspole IN, Jo HE, Bleasel JF, Wrobel JP, Dowman L, Parker MJS, Wilsher ML, Goh NSL, Moodley Y, Keir GJ. Diagnosis and management of connective tissue disease-associated interstitial lung disease in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand. Respirology 2020; 26:23-51. [PMID: 33233015 PMCID: PMC7894187 DOI: 10.1111/resp.13977] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/26/2020] [Accepted: 10/22/2020] [Indexed: 12/12/2022]
Abstract
Pulmonary complications in CTD are common and can involve the interstitium, airways, pleura and pulmonary vasculature. ILD can occur in all CTD (CTD-ILD), and may vary from limited, non-progressive lung involvement, to fulminant, life-threatening disease. Given the potential for major adverse outcomes in CTD-ILD, accurate diagnosis, assessment and careful consideration of therapeutic intervention are a priority. Limited data are available to guide management decisions in CTD-ILD. Autoimmune-mediated pulmonary inflammation is considered a key pathobiological pathway in these disorders, and immunosuppressive therapy is generally regarded the cornerstone of treatment for severe and/or progressive CTD-ILD. However, the natural history of CTD-ILD in individual patients can be difficult to predict, and deciding who to treat, when and with what agent can be challenging. Establishing realistic therapeutic goals from both the patient and clinician perspective requires considerable expertise. The document aims to provide a framework for clinicians to aid in the assessment and management of ILD in the major CTD. A suggested approach to diagnosis and monitoring of CTD-ILD and, where available, evidence-based, disease-specific approaches to treatment have been provided.
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Affiliation(s)
- Adelle S Jee
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia
| | - Robert Sheehy
- Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Peter Hopkins
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia.,Queensland Lung Transplant service, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Tamera J Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia
| | - Christopher Grainge
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,Department of Respiratory Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Lauren K Troy
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Karen Symons
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Lissa M Spencer
- Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Paul N Reynolds
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia.,Lung Research Laboratory, University of Adelaide, Adelaide, SA, Australia
| | - Sally Chapman
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sally de Boer
- Respiratory Services, Auckland District Health Board, Auckland, New Zealand
| | - Taryn Reddy
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Anne E Holland
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, VIC, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Daniel C Chambers
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia.,Queensland Lung Transplant service, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Ian N Glaspole
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia.,Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Helen E Jo
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Central Clinical School, University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia
| | - Jane F Bleasel
- Central Clinical School, University of Sydney, Sydney, NSW, Australia.,Department of Rheumatology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jeremy P Wrobel
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Perth, WA, Australia.,Department of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Leona Dowman
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, VIC, Australia.,Physiotherapy Department, Austin Health, Melbourne, VIC, Australia
| | - Matthew J S Parker
- Central Clinical School, University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,Department of Rheumatology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Margaret L Wilsher
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,Respiratory Services, Auckland District Health Board, Auckland, New Zealand.,Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nicole S L Goh
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia.,Department of Respiratory Medicine, Austin Hospital, Melbourne, VIC, Australia.,Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Yuben Moodley
- NHMRC Centre of Research Excellence in Pulmonary Fibrosis, Sydney, NSW, Australia.,University of Western Australia, Institute for Respiratory Health, Perth, WA, Australia.,Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA, Australia
| | - Gregory J Keir
- Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
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11
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Ruano CA, Grafino M, Borba A, Pinheiro S, Fernandes O, Silva SC, Bilhim T, Moraes-Fontes MF, Irion KL. Multimodality imaging in connective tissue disease-related interstitial lung disease. Clin Radiol 2020; 76:88-98. [PMID: 32868089 DOI: 10.1016/j.crad.2020.07.035] [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: 03/04/2020] [Accepted: 07/28/2020] [Indexed: 11/18/2022]
Abstract
Interstitial lung disease is a well-recognised manifestation and a major cause of morbidity and mortality in patients with connective tissue diseases. Interstitial lung disease may arise in the context of an established connective tissue disease or be the initial manifestation of an otherwise occult autoimmune disorder. Early detection and characterisation are paramount for adequate patient management and require a multidisciplinary approach, in which imaging plays a vital role. Computed tomography is currently the imaging method of choice; however, other imaging techniques have recently been investigated, namely ultrasound, magnetic resonance imaging, and positron-emission tomography, with promising results. The aim of this review is to describe the imaging findings of connective tissue disease-related interstitial lung disease and explain the role of each imaging technique in diagnosis and disease characterisation.
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Affiliation(s)
- C A Ruano
- Radiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Radiology Department, Hospital da Luz, Lisboa, Portugal; NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.
| | - M Grafino
- Pulmonology Department, Hospital da Luz, Lisboa, Portugal
| | - A Borba
- Pulmonology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - S Pinheiro
- Autoimmune Disease Unit, Unidade de Doenças Auto-imunes/Serviço Medicina 3, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - O Fernandes
- Radiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal; Radiology Department, Hospital da Luz, Lisboa, Portugal
| | - S C Silva
- Radiology Department, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - T Bilhim
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal; Interventional Radiology Unit, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - M F Moraes-Fontes
- Autoimmune Disease Unit, Unidade de Doenças Auto-imunes/Serviço Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - K L Irion
- Radiology Department, Manchester Royal Infirmary, Manchester, United Kingdom; University of Manchester, Division of Infection Immunity & Respiratory Medicine, School of Biological Sciences, Manchester, United Kingdom
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12
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Connective tissue disease--associated interstitial lung disease: an underreported cause of interstitial lung disease in Sub-Saharan Africa. Clin Rheumatol 2020; 40:3455-3460. [PMID: 32803569 DOI: 10.1007/s10067-020-05336-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/28/2020] [Accepted: 08/08/2020] [Indexed: 11/27/2022]
Abstract
Interstitial lung disease (ILD) occurs in 15% of connective tissue disease (CTD) patients causing considerable morbidity and mortality. Data is scarce regarding its clinical characteristics and outcomes in Africa. We aim to study the frequency, clinico-radiological characteristics, and treatment outcomes of African CTD-ILD patients. A retrospective cross-sectional study of ILD among 318 CTD patients diagnosed using relevant ACR criteria at the rheumatology unit of Lagos State University Teaching Hospital (LASUTH), Lagos from 2012 to 2019. Socio-demographics, clinical features, radiological findings, and treatment outcomes were documented. Data was analyzed using SPSS version 21 with p < 0.05. The LASUTH ethics committee approved the study. Interstitial lung disease occurred in 31 (9.7%) of 318 CTD cases. Their mean age was 38.8 ± 13.3 years, range 19-68 years with 28 (90.3%) females. Proportions of CTD-ILD were Sjogren's syndrome (50%), UCTD (50%), systemic sclerosis (46.7%), MCTD (33.3%), PM/DM (25%), SLE (6.5%), and RA (2.6%). Commonest presentations were cough (93.5%) and bibasal inspiratory crackles (83.9%) with a restrictive pattern in 83.9%. Antinuclear antibody occurred in 100% and anti-ENA in 67.7%. Traction bronchiectasis (89.7%) and ground glass opacities (96.6%) were frequent HRCT findings. Treatments included pulse-dose prednisolone, cyclophosphamide, mycophenolate mofetil, pirfenidone, and rituximab. Outcomes were ambulatory oxygen therapy (12.9%) and mortality (16.1%) with 9.7% lost to follow-up. CTD-ILD is a female predominant disease occurring in 9.7% of CTD patients mostly those with Sjogren's syndrome and systemic sclerosis. Due to significant morbidity and mortality, we advocate routine ILD screening for all CTD patients including those with undifferentiated disease. Key Points: • Interstitial lung disease occurs in 9.7% of patients with underlying connective tissue disease. • Females are predominantly affected especially those with Sjogren's syndrome and systemic sclerosis. • Mortality occurs in roughly 1 in every 6 patients with CTD-ILD.
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13
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Kusmirek JE, Kanne JP. Thoracic Manifestations of Connective Tissue Diseases. Semin Ultrasound CT MR 2019; 40:239-254. [DOI: 10.1053/j.sult.2018.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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14
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Mira-Avendano I, Abril A, Burger CD, Dellaripa PF, Fischer A, Gotway MB, Lee AS, Lee JS, Matteson EL, Yi ES, Ryu JH. Interstitial Lung Disease and Other Pulmonary Manifestations in Connective Tissue Diseases. Mayo Clin Proc 2019; 94:309-325. [PMID: 30558827 DOI: 10.1016/j.mayocp.2018.09.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/24/2018] [Accepted: 09/17/2018] [Indexed: 12/22/2022]
Abstract
Lung involvement in connective tissue diseases is associated with substantial morbidity and mortality, most commonly in the form of interstitial lung disease, and can occur in any of these disorders. Patterns of interstitial lung disease in patients with connective tissue disease are similar to those seen in idiopathic interstitial pneumonias, such as idiopathic pulmonary fibrosis. It may be difficult to distinguish between the 2 ailments, particularly when interstitial lung disease presents before extrapulmonary manifestations of the underlying connective tissue disease. There are important clinical implications in achieving this distinction. Given the complexities inherent in the management of these patients, a multidisciplinary evaluation is needed to optimize the diagnostic process and management strategies. The aim of this article was to summarize an approach to diagnosis and management based on the opinion of experts on this topic.
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Affiliation(s)
- Isabel Mira-Avendano
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, FL.
| | - Andy Abril
- Division of Rheumatology, Mayo Clinic, Jacksonville, FL
| | - Charles D Burger
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, FL
| | - Paul F Dellaripa
- Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Aryeh Fischer
- Department of Medicine, University of Colorado, Denver, Aurora, CO
| | - Michael B Gotway
- Division of Cardiothoracic Radiology, Mayo Clinic, Scottsdale, AZ
| | - Augustine S Lee
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, FL
| | - Joyce S Lee
- Department of Medicine, University of Colorado, Denver, Aurora, CO
| | - Eric L Matteson
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN
| | - Eunhee S Yi
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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15
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Abstract
More than 100 different conditions are grouped under the term interstitial lung disease (ILD). A diagnosis of an ILD primarily relies on a combination of clinical, radiological, and pathological criteria, which should be evaluated by a multidisciplinary team of specialists. Multiple factors, such as environmental and occupational exposures, infections, drugs, radiation, and genetic predisposition have been implicated in the pathogenesis of these conditions. Asbestosis and other pneumoconiosis, hypersensitivity pneumonitis (HP), chronic beryllium disease, and smoking-related ILD are specifically linked to inhalational exposure of environmental agents. The recent Global Burden of Disease Study reported that ILD rank 40th in relation to global years of life lost in 2013, which represents an increase of 86% compared to 1990. Idiopathic pulmonary fibrosis (IPF) is the prototype of fibrotic ILD. A recent study from the United States reported that the incidence and prevalence of IPF are 14.6 per 100,000 person-years and 58.7 per 100,000 persons, respectively. These data suggests that, in large populated areas such as Brazil, Russia, India, and China (the BRIC region), there may be approximately 2 million people living with IPF. However, studies from South America found much lower rates (0.4–1.2 cases per 100,000 per year). Limited access to high-resolution computed tomography and spirometry or to multidisciplinary teams for accurate diagnosis and optimal treatment are common challenges to the management of ILD in developing countries.
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16
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Zhao L, Mu B, Zhou R, Cheng Y, Huang C. Iguratimod ameliorates bleomycin‐induced alveolar inflammation and pulmonary fibrosis in mice by suppressing expression of matrix metalloproteinase‐9. Int J Rheum Dis 2019; 22:686-694. [PMID: 30666825 DOI: 10.1111/1756-185x.13463] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 11/16/2018] [Accepted: 11/22/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Like Zhao
- Department of Rheumatology, Beijing Hospital National Center of Gerontology Beijing China
| | - Bingyao Mu
- Department of Rheumatology, Beijing Hospital National Center of Gerontology Beijing China
- Department of Nephrology Miyun Teaching Hospital of Capital Medical University Beijing China
| | - Rongwei Zhou
- Department of Rheumatology, Beijing Hospital National Center of Gerontology Beijing China
- Department of Rheumatology, Shanghai Sixth People's Hospital Shanghai Jiaotong University Shanghai China
| | - Yongjing Cheng
- Department of Rheumatology, Beijing Hospital National Center of Gerontology Beijing China
| | - Cibo Huang
- Department of Rheumatology, Beijing Hospital National Center of Gerontology Beijing China
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17
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Kwon KY. Pathological interpretation of connective tissue disease-associated lung diseases. Yeungnam Univ J Med 2019; 36:8-15. [PMID: 31620606 PMCID: PMC6784620 DOI: 10.12701/yujm.2019.00101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 12/17/2022] Open
Abstract
Connective tissue diseases (CTDs) can affect all compartments of the lungs, including airways, alveoli, interstitium, vessels, and pleura. CTD-associated lung diseases (CTD-LDs) may present as diffuse lung disease or as focal lesions, and there is significant heterogeneity between the individual CTDs in their clinical and pathological manifestations. CTD-LDs may presage the clinical diagnosis a primary CTD, or it may develop in the context of an established CTD diagnosis. CTD-LDs reveal acute, chronic or mixed pattern of lung and pleural manifestations. Histopathological findings of diverse morphological changes can be present in CTD-LDs airway lesions (chronic bronchitis/bronchiolitis, follicular bronchiolitis, etc.), interstitial lung diseases (nonspecific interstitial pneumonia/fibrosis, usual interstitial pneumonia, lymphocytic interstitial pneumonia, diffuse alveolar damage, and organizing pneumonia), pleural changes (acute fibrinous or chronic fibrous pleuritis), and vascular changes (vasculitis, capillaritis, pulmonary hemorrhage, etc.). CTD patients can be exposed to various infectious diseases when taking immunosuppressive drugs. Histopathological patterns of CTD-LDs are generally nonspecific, and other diseases that can cause similar lesions in the lungs must be considered before the diagnosis of CTD-LDs. A multidisciplinary team involving pathologists, clinicians, and radiologists can adequately make a proper diagnosis of CTD-LDs.
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Affiliation(s)
- Kun Young Kwon
- Department of Pathology, Dongkang Hospital, Ulsan, Korea
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18
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Ahuja J, Arora D, Kanne JP, Henry TS, Godwin JD. Imaging of Pulmonary Manifestations of Connective Tissue Diseases. Radiol Clin North Am 2016; 54:1015-1031. [DOI: 10.1016/j.rcl.2016.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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19
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Bahmer T, Romagnoli M, Girelli F, Claussen M, Rabe KF. The use of auto-antibody testing in the evaluation of interstitial lung disease (ILD) – A practical approach for the pulmonologist. Respir Med 2016; 113:80-92. [DOI: 10.1016/j.rmed.2016.01.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 10/27/2015] [Accepted: 01/28/2016] [Indexed: 11/29/2022]
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20
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Ferri C, Manfredi A, Sebastiani M, Colaci M, Giuggioli D, Vacchi C, Della Casa G, Cerri S, Torricelli P, Luppi F. Interstitial pneumonia with autoimmune features and undifferentiated connective tissue disease. Autoimmun Rev 2016; 15:61-70. [DOI: 10.1016/j.autrev.2015.09.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 09/08/2015] [Indexed: 12/30/2022]
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Abstract
PURPOSE OF REVIEW This review aims to provide a literature update focused on the role of imaging in the diagnosis, prognosis and quantification of interstitial lung diseases (ILDs). Special emphasis is given in the management of atypical cases and in the multidisciplinary team approach in reaching the diagnosis of the various ILDs. RECENT FINDINGS Accumulated knowledge on imaging has increased the accuracy of differential diagnosis in atypical cases, in overlap of findings and in secondary as opposed to idiopathic ILDs. There is increasing awareness about interstitial lung abnormalities in smokers' lungs from lung cancer screening and indirect evidence of linkage of fibrosis and smoking. Improvement in radiologic-pathologic correlation reveals less typical high-resolution computed tomography patterns to be predictive of pulmonary fibrosis. Major diagnostic criteria such as honeycombing may be hampered by the coexistence of emphysema. High-resolution computed tomography may predict clinical outcome and survival of patients in ILDs and is a decision maker in the multidisciplinary approach of diagnosis. SUMMARY High-resolution computed tomography plays a crucial role in the diagnosis, prognosis, quantification and monitoring of ILDs. It provides a definite noninvasive diagnosis in typical findings and helps in reaching the most accurate diagnosis in a multidisciplinary discussion in equivocal cases.
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Ahmed F, Raslan O, Muzaffar R, Parkar N, Marwaha N, Osman MM. Sjögren Syndrome Complicated by Mucosa-Associated Lymphoid Tissue Lymphoma and Lymphocytic Interstitial Pneumonia. Front Oncol 2015; 5:179. [PMID: 26301203 PMCID: PMC4526815 DOI: 10.3389/fonc.2015.00179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 07/21/2015] [Indexed: 11/30/2022] Open
Abstract
Sjögren syndrome (SS) is an autoimmune disease with exocrine glands dysfunction and multiorgan involvement. It is associated with increased risk of lymphoproliferative disorders, especially B-cell marginal zone lymphoma. While the role of F-18 Fluorodeoxyglucose position emission tomography/computed tomography (F-18 FDG PET/CT) for evaluation of lymphoma has been established, its use in patients with a chronic history of SS to evaluate for possible lymphoproliferative disorders or multiorgan involvement is limited. We present a case of chronic SS in which F-18 FDG PET/CT demonstrated FDG avid intraparotid and cervical lymph nodes pathologically proven to be mucosa-associated lymphoid tissue lymphoma. In addition, the patient had bibasilar cystic changes consistent with lymphocytic interstitial pneumonia.
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Affiliation(s)
- Fatma Ahmed
- Saint Louis Univeristy , Saint Louis, MO , USA
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23
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Khanna D, Mittoo S, Aggarwal R, Proudman SM, Dalbeth N, Matteson EL, Brown K, Flaherty K, Wells AU, Seibold JR, Strand V. Connective Tissue Disease-associated Interstitial Lung Diseases (CTD-ILD) - Report from OMERACT CTD-ILD Working Group. J Rheumatol 2015; 42:2168-71. [PMID: 25729034 DOI: 10.3899/jrheum.141182] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Interstitial lung disease (ILD) is common in connective tissue disease (CTD) and is the leading cause of mortality. Investigators have used certain outcome measures in randomized controlled trials (RCT) in CTD-ILD, but the lack of a systematically developed, CTD-specific index that captures all measures relevant and meaningful to patients with CTD-ILD has left a large and conspicuous gap in CTD-ILD research. METHODS The CTD-ILD working group, under the aegis of the Outcome Measures in Rheumatology (OMERACT) initiative, has completed a consensus group exercise to reach harmony on core domains and items for inclusion in RCT in CTD-ILD. During the OMERACT 12 meeting, consensus was sought on domains and core items for inclusion in RCT. In addition, consensus was pursued on a definition of response in RCT. Consensus was defined as ≥ 75% agreement among the participants. RESULTS OMERACT 12 participants endorsed the domains with minimal modifications. Clinically meaningful progression for CTD-ILD was proposed as ≥ 10% relative decline in forced vital capacity (FVC) or ≥ 5% to < 10% relative decline in FVC and ≥ 15% relative decline in DLCO. CONCLUSION There is consensus on domains for inclusion in RCT in CTD-ILD and on a definition of clinically meaningful progression. Data-driven approaches to validate these results in different cohorts and RCT are needed.
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Affiliation(s)
- Dinesh Khanna
- From the Department of Internal Medicine, Division of Rheumatology, University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA; University of Toronto, Toronto, Ontario, Canada; University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Royal Adelaide Hospital and University of Adelaide, Adelaide, Australia; University of Auckland, Auckland, New Zealand; Mayo Clinic, Rochester, Minnesota; National Jewish Hospital, Denver, Colorado, USA; Royal Brompton Hospital and National Heart and Lung Institute, London, UK; Scleroderma Research Consultants, Litchfield, Connecticut; Vibeke Strand, MD, Stanford University, Palo Alto, California, USA.D. Khanna, MD, MSc, Associate Professor of Medicine, Director, University of Michigan Scleroderma Program, University of Michigan; S. Mittoo, MD, MHS, University of Toronto; R. Aggarwal, MD, MS, Assistant Professor of Medicine, University of Pittsburgh; S.M. Proudman, MBBS, Royal Adelaide Hospital and Associate Professor Discipline of Medicine, University of Adelaide; N. Dalbeth, MD, FRACP, University of Auckland; E.L. Matteson, MD, Mayo Clinic; K. Brown, MD, National Jewish Hospital; K. Flahery, MD, MSc, Professor of Medicine, University of Michigan; A.U. Wells, MD, Royal Brompton Hospital and National Heart and Lung Institute; J.R. Seibold, MD, Scleroderma Research Consultants; V. Strand, MD, Stanford University.
| | - Shikha Mittoo
- From the Department of Internal Medicine, Division of Rheumatology, University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA; University of Toronto, Toronto, Ontario, Canada; University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Royal Adelaide Hospital and University of Adelaide, Adelaide, Australia; University of Auckland, Auckland, New Zealand; Mayo Clinic, Rochester, Minnesota; National Jewish Hospital, Denver, Colorado, USA; Royal Brompton Hospital and National Heart and Lung Institute, London, UK; Scleroderma Research Consultants, Litchfield, Connecticut; Vibeke Strand, MD, Stanford University, Palo Alto, California, USA.D. Khanna, MD, MSc, Associate Professor of Medicine, Director, University of Michigan Scleroderma Program, University of Michigan; S. Mittoo, MD, MHS, University of Toronto; R. Aggarwal, MD, MS, Assistant Professor of Medicine, University of Pittsburgh; S.M. Proudman, MBBS, Royal Adelaide Hospital and Associate Professor Discipline of Medicine, University of Adelaide; N. Dalbeth, MD, FRACP, University of Auckland; E.L. Matteson, MD, Mayo Clinic; K. Brown, MD, National Jewish Hospital; K. Flahery, MD, MSc, Professor of Medicine, University of Michigan; A.U. Wells, MD, Royal Brompton Hospital and National Heart and Lung Institute; J.R. Seibold, MD, Scleroderma Research Consultants; V. Strand, MD, Stanford University
| | - Rohit Aggarwal
- From the Department of Internal Medicine, Division of Rheumatology, University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA; University of Toronto, Toronto, Ontario, Canada; University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Royal Adelaide Hospital and University of Adelaide, Adelaide, Australia; University of Auckland, Auckland, New Zealand; Mayo Clinic, Rochester, Minnesota; National Jewish Hospital, Denver, Colorado, USA; Royal Brompton Hospital and National Heart and Lung Institute, London, UK; Scleroderma Research Consultants, Litchfield, Connecticut; Vibeke Strand, MD, Stanford University, Palo Alto, California, USA.D. Khanna, MD, MSc, Associate Professor of Medicine, Director, University of Michigan Scleroderma Program, University of Michigan; S. Mittoo, MD, MHS, University of Toronto; R. Aggarwal, MD, MS, Assistant Professor of Medicine, University of Pittsburgh; S.M. Proudman, MBBS, Royal Adelaide Hospital and Associate Professor Discipline of Medicine, University of Adelaide; N. Dalbeth, MD, FRACP, University of Auckland; E.L. Matteson, MD, Mayo Clinic; K. Brown, MD, National Jewish Hospital; K. Flahery, MD, MSc, Professor of Medicine, University of Michigan; A.U. Wells, MD, Royal Brompton Hospital and National Heart and Lung Institute; J.R. Seibold, MD, Scleroderma Research Consultants; V. Strand, MD, Stanford University
| | - Susanna M Proudman
- From the Department of Internal Medicine, Division of Rheumatology, University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA; University of Toronto, Toronto, Ontario, Canada; University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Royal Adelaide Hospital and University of Adelaide, Adelaide, Australia; University of Auckland, Auckland, New Zealand; Mayo Clinic, Rochester, Minnesota; National Jewish Hospital, Denver, Colorado, USA; Royal Brompton Hospital and National Heart and Lung Institute, London, UK; Scleroderma Research Consultants, Litchfield, Connecticut; Vibeke Strand, MD, Stanford University, Palo Alto, California, USA.D. Khanna, MD, MSc, Associate Professor of Medicine, Director, University of Michigan Scleroderma Program, University of Michigan; S. Mittoo, MD, MHS, University of Toronto; R. Aggarwal, MD, MS, Assistant Professor of Medicine, University of Pittsburgh; S.M. Proudman, MBBS, Royal Adelaide Hospital and Associate Professor Discipline of Medicine, University of Adelaide; N. Dalbeth, MD, FRACP, University of Auckland; E.L. Matteson, MD, Mayo Clinic; K. Brown, MD, National Jewish Hospital; K. Flahery, MD, MSc, Professor of Medicine, University of Michigan; A.U. Wells, MD, Royal Brompton Hospital and National Heart and Lung Institute; J.R. Seibold, MD, Scleroderma Research Consultants; V. Strand, MD, Stanford University
| | - Nicola Dalbeth
- From the Department of Internal Medicine, Division of Rheumatology, University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA; University of Toronto, Toronto, Ontario, Canada; University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Royal Adelaide Hospital and University of Adelaide, Adelaide, Australia; University of Auckland, Auckland, New Zealand; Mayo Clinic, Rochester, Minnesota; National Jewish Hospital, Denver, Colorado, USA; Royal Brompton Hospital and National Heart and Lung Institute, London, UK; Scleroderma Research Consultants, Litchfield, Connecticut; Vibeke Strand, MD, Stanford University, Palo Alto, California, USA.D. Khanna, MD, MSc, Associate Professor of Medicine, Director, University of Michigan Scleroderma Program, University of Michigan; S. Mittoo, MD, MHS, University of Toronto; R. Aggarwal, MD, MS, Assistant Professor of Medicine, University of Pittsburgh; S.M. Proudman, MBBS, Royal Adelaide Hospital and Associate Professor Discipline of Medicine, University of Adelaide; N. Dalbeth, MD, FRACP, University of Auckland; E.L. Matteson, MD, Mayo Clinic; K. Brown, MD, National Jewish Hospital; K. Flahery, MD, MSc, Professor of Medicine, University of Michigan; A.U. Wells, MD, Royal Brompton Hospital and National Heart and Lung Institute; J.R. Seibold, MD, Scleroderma Research Consultants; V. Strand, MD, Stanford University
| | - Eric L Matteson
- From the Department of Internal Medicine, Division of Rheumatology, University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA; University of Toronto, Toronto, Ontario, Canada; University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Royal Adelaide Hospital and University of Adelaide, Adelaide, Australia; University of Auckland, Auckland, New Zealand; Mayo Clinic, Rochester, Minnesota; National Jewish Hospital, Denver, Colorado, USA; Royal Brompton Hospital and National Heart and Lung Institute, London, UK; Scleroderma Research Consultants, Litchfield, Connecticut; Vibeke Strand, MD, Stanford University, Palo Alto, California, USA.D. Khanna, MD, MSc, Associate Professor of Medicine, Director, University of Michigan Scleroderma Program, University of Michigan; S. Mittoo, MD, MHS, University of Toronto; R. Aggarwal, MD, MS, Assistant Professor of Medicine, University of Pittsburgh; S.M. Proudman, MBBS, Royal Adelaide Hospital and Associate Professor Discipline of Medicine, University of Adelaide; N. Dalbeth, MD, FRACP, University of Auckland; E.L. Matteson, MD, Mayo Clinic; K. Brown, MD, National Jewish Hospital; K. Flahery, MD, MSc, Professor of Medicine, University of Michigan; A.U. Wells, MD, Royal Brompton Hospital and National Heart and Lung Institute; J.R. Seibold, MD, Scleroderma Research Consultants; V. Strand, MD, Stanford University
| | - Kevin Brown
- From the Department of Internal Medicine, Division of Rheumatology, University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA; University of Toronto, Toronto, Ontario, Canada; University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Royal Adelaide Hospital and University of Adelaide, Adelaide, Australia; University of Auckland, Auckland, New Zealand; Mayo Clinic, Rochester, Minnesota; National Jewish Hospital, Denver, Colorado, USA; Royal Brompton Hospital and National Heart and Lung Institute, London, UK; Scleroderma Research Consultants, Litchfield, Connecticut; Vibeke Strand, MD, Stanford University, Palo Alto, California, USA.D. Khanna, MD, MSc, Associate Professor of Medicine, Director, University of Michigan Scleroderma Program, University of Michigan; S. Mittoo, MD, MHS, University of Toronto; R. Aggarwal, MD, MS, Assistant Professor of Medicine, University of Pittsburgh; S.M. Proudman, MBBS, Royal Adelaide Hospital and Associate Professor Discipline of Medicine, University of Adelaide; N. Dalbeth, MD, FRACP, University of Auckland; E.L. Matteson, MD, Mayo Clinic; K. Brown, MD, National Jewish Hospital; K. Flahery, MD, MSc, Professor of Medicine, University of Michigan; A.U. Wells, MD, Royal Brompton Hospital and National Heart and Lung Institute; J.R. Seibold, MD, Scleroderma Research Consultants; V. Strand, MD, Stanford University
| | - Kevin Flaherty
- From the Department of Internal Medicine, Division of Rheumatology, University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA; University of Toronto, Toronto, Ontario, Canada; University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Royal Adelaide Hospital and University of Adelaide, Adelaide, Australia; University of Auckland, Auckland, New Zealand; Mayo Clinic, Rochester, Minnesota; National Jewish Hospital, Denver, Colorado, USA; Royal Brompton Hospital and National Heart and Lung Institute, London, UK; Scleroderma Research Consultants, Litchfield, Connecticut; Vibeke Strand, MD, Stanford University, Palo Alto, California, USA.D. Khanna, MD, MSc, Associate Professor of Medicine, Director, University of Michigan Scleroderma Program, University of Michigan; S. Mittoo, MD, MHS, University of Toronto; R. Aggarwal, MD, MS, Assistant Professor of Medicine, University of Pittsburgh; S.M. Proudman, MBBS, Royal Adelaide Hospital and Associate Professor Discipline of Medicine, University of Adelaide; N. Dalbeth, MD, FRACP, University of Auckland; E.L. Matteson, MD, Mayo Clinic; K. Brown, MD, National Jewish Hospital; K. Flahery, MD, MSc, Professor of Medicine, University of Michigan; A.U. Wells, MD, Royal Brompton Hospital and National Heart and Lung Institute; J.R. Seibold, MD, Scleroderma Research Consultants; V. Strand, MD, Stanford University
| | - Athol U Wells
- From the Department of Internal Medicine, Division of Rheumatology, University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA; University of Toronto, Toronto, Ontario, Canada; University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Royal Adelaide Hospital and University of Adelaide, Adelaide, Australia; University of Auckland, Auckland, New Zealand; Mayo Clinic, Rochester, Minnesota; National Jewish Hospital, Denver, Colorado, USA; Royal Brompton Hospital and National Heart and Lung Institute, London, UK; Scleroderma Research Consultants, Litchfield, Connecticut; Vibeke Strand, MD, Stanford University, Palo Alto, California, USA.D. Khanna, MD, MSc, Associate Professor of Medicine, Director, University of Michigan Scleroderma Program, University of Michigan; S. Mittoo, MD, MHS, University of Toronto; R. Aggarwal, MD, MS, Assistant Professor of Medicine, University of Pittsburgh; S.M. Proudman, MBBS, Royal Adelaide Hospital and Associate Professor Discipline of Medicine, University of Adelaide; N. Dalbeth, MD, FRACP, University of Auckland; E.L. Matteson, MD, Mayo Clinic; K. Brown, MD, National Jewish Hospital; K. Flahery, MD, MSc, Professor of Medicine, University of Michigan; A.U. Wells, MD, Royal Brompton Hospital and National Heart and Lung Institute; J.R. Seibold, MD, Scleroderma Research Consultants; V. Strand, MD, Stanford University
| | - James R Seibold
- From the Department of Internal Medicine, Division of Rheumatology, University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA; University of Toronto, Toronto, Ontario, Canada; University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Royal Adelaide Hospital and University of Adelaide, Adelaide, Australia; University of Auckland, Auckland, New Zealand; Mayo Clinic, Rochester, Minnesota; National Jewish Hospital, Denver, Colorado, USA; Royal Brompton Hospital and National Heart and Lung Institute, London, UK; Scleroderma Research Consultants, Litchfield, Connecticut; Vibeke Strand, MD, Stanford University, Palo Alto, California, USA.D. Khanna, MD, MSc, Associate Professor of Medicine, Director, University of Michigan Scleroderma Program, University of Michigan; S. Mittoo, MD, MHS, University of Toronto; R. Aggarwal, MD, MS, Assistant Professor of Medicine, University of Pittsburgh; S.M. Proudman, MBBS, Royal Adelaide Hospital and Associate Professor Discipline of Medicine, University of Adelaide; N. Dalbeth, MD, FRACP, University of Auckland; E.L. Matteson, MD, Mayo Clinic; K. Brown, MD, National Jewish Hospital; K. Flahery, MD, MSc, Professor of Medicine, University of Michigan; A.U. Wells, MD, Royal Brompton Hospital and National Heart and Lung Institute; J.R. Seibold, MD, Scleroderma Research Consultants; V. Strand, MD, Stanford University
| | - Vibeke Strand
- From the Department of Internal Medicine, Division of Rheumatology, University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA; University of Toronto, Toronto, Ontario, Canada; University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Royal Adelaide Hospital and University of Adelaide, Adelaide, Australia; University of Auckland, Auckland, New Zealand; Mayo Clinic, Rochester, Minnesota; National Jewish Hospital, Denver, Colorado, USA; Royal Brompton Hospital and National Heart and Lung Institute, London, UK; Scleroderma Research Consultants, Litchfield, Connecticut; Vibeke Strand, MD, Stanford University, Palo Alto, California, USA.D. Khanna, MD, MSc, Associate Professor of Medicine, Director, University of Michigan Scleroderma Program, University of Michigan; S. Mittoo, MD, MHS, University of Toronto; R. Aggarwal, MD, MS, Assistant Professor of Medicine, University of Pittsburgh; S.M. Proudman, MBBS, Royal Adelaide Hospital and Associate Professor Discipline of Medicine, University of Adelaide; N. Dalbeth, MD, FRACP, University of Auckland; E.L. Matteson, MD, Mayo Clinic; K. Brown, MD, National Jewish Hospital; K. Flahery, MD, MSc, Professor of Medicine, University of Michigan; A.U. Wells, MD, Royal Brompton Hospital and National Heart and Lung Institute; J.R. Seibold, MD, Scleroderma Research Consultants; V. Strand, MD, Stanford University
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Abstract
The pathologic correlates of interstitial lung disease (ILD) secondary to connective tissue disease (CTD) comprise a diverse group of histologic patterns. Lung biopsies in patients with CTD-associated ILD tend to demonstrate simultaneous involvement of multiple anatomic compartments of the lung. Certain histologic patterns tend to predominate in each defined CTD, and it is possible in many cases to confirm connective tissue-associated lung disease and guide patient management using surgical lung biopsy. This article will cover the pulmonary pathologies seen in rheumatoid arthritis, systemic sclerosis, myositis, systemic lupus erythematosus, Sjögren syndrome, and mixed CTD.
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Ruano CA, Lucas RN, Leal CI, Lourenço J, Pinheiro S, Fernandes O, Figueiredo L. Thoracic Manifestations of Connective Tissue Diseases. Curr Probl Diagn Radiol 2015; 44:47-59. [DOI: 10.1067/j.cpradiol.2014.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 06/27/2014] [Accepted: 07/13/2014] [Indexed: 01/15/2023]
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