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Kallianos K. Imaging of Pulmonary Manifestations of Connective Tissue Disease. Rheum Dis Clin North Am 2024; 50:409-422. [PMID: 38942577 DOI: 10.1016/j.rdc.2024.03.002] [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] [Indexed: 06/30/2024]
Abstract
The majority of connective tissue diseases (CTDs) are multisystem disorders that are often heterogeneous in their presentation and do not have a single laboratory, histologic, or radiologic feature that is defined as the gold standard to support a specific diagnosis. Given this challenging situation, the diagnosis of CTD is a process that requires the synthesis of multidisciplinary data which may include patient clinical symptoms, serologic evaluation, laboratory testing, and imaging. Pulmonary manifestations of connective tissue disease include interstitial lung disease as well as multicompartmental manifestations. These CT imaging patterns and features of specific diseases will be discussed in this article.
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Affiliation(s)
- Kimberly Kallianos
- Department of Radiology and Biomedical Imaging, UCSF, 505 Parnassus Avenue, M391, San Francisco, CA 94143, USA.
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Jeon H, Nam BD, Yoon CH, Kim HS. Radiologic approach and progressive exploration of connective tissue disease-related interstitial lung disease: meeting the curiosity of rheumatologists. JOURNAL OF RHEUMATIC DISEASES 2024; 31:3-14. [PMID: 38130961 PMCID: PMC10730800 DOI: 10.4078/jrd.2023.0042] [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: 07/28/2023] [Revised: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 12/23/2023]
Abstract
Interstitial lung disease (ILD) is often observed in connective tissue diseases (CTDs), frequently in rheumatoid arthritis, systemic sclerosis, primary Sjögren's syndrome, and inflammatory myositis. Early detection of ILDs secondary to rheumatic diseases is important as timely initiation of proper management affects the prognosis. Among many imaging modalities, high-resuloution computed tomography (HRCT) serves the gold standard for finding early lung inflammatory and fibrotic changes as well as monitoring afterwards because of its superior spatial resolution. Additionally, lung ultrasound (LUS) and magnetic resonance imaging (MRI) are the rising free-radiation imaging tools that can get images of lungs of CTD-ILD. In this review article, we present the subtypes of ILD images found in each CTD acquired by HRCT as well as some images taken by LUS and MRI with comparative HRCT scans. It is expected that this discussion would be helpful in discussing recent advances in imaging modalities for CTD-ILD and raising critical points for diagnosis and tracing of the images from the perspective of rheumatologists.
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Affiliation(s)
- Hyeji Jeon
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Bo Da Nam
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Chong-Hyeon Yoon
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun-Sook Kim
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Fairley JL, Ross L, Burns A, Prior D, Conron M, Rouse H, McDonald J, MacIsaac A, La Gerche A, Morrisroe K, Ferdowsi N, Quinlivan A, Brown Z, Stevens W, Nikpour M. Multidisciplinary team discussion: the emerging gold standard for management of cardiopulmonary complications of connective tissue disease. Intern Med J 2023; 53:1919-1924. [PMID: 37772776 PMCID: PMC10947227 DOI: 10.1111/imj.16233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023]
Abstract
Cardiopulmonary complications of connective tissue diseases (CTDs), particularly pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD), are major determinants of morbidity and mortality. Multidisciplinary meetings may improve diagnostic accuracy and optimise treatment. We review the literature regarding multidisciplinary meetings in CTD-ILD and PAH and describe our tertiary centre experience of the role of the multidisciplinary meeting in managing CTD-PAH.
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Affiliation(s)
- Jessica L. Fairley
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Laura Ross
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Andrew Burns
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of CardiologySt Vincent's Hospital MelbourneMelbourneAustralia
| | - David Prior
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of CardiologySt Vincent's Hospital MelbourneMelbourneAustralia
| | - Matthew Conron
- Department of Respiratory MedicineSt Vincent's Hospital MelbourneMelbourneAustralia
| | - Hannah Rouse
- Department of RadiologySt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Julie McDonald
- Department of Respiratory MedicineSt Vincent's Hospital MelbourneMelbourneAustralia
| | - Andrew MacIsaac
- Department of CardiologySt Vincent's Hospital MelbourneMelbourneAustralia
| | - André La Gerche
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Baker Heart and Diabetes InstituteVictoriaAustralia
| | - Kathleen Morrisroe
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Nava Ferdowsi
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Alannah Quinlivan
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Zoe Brown
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Wendy Stevens
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Mandana Nikpour
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
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Sanduzzi Zamparelli S, Sanduzzi Zamparelli A, Bocchino M. The Evolving Concept of the Multidisciplinary Approach in the Diagnosis and Management of Interstitial Lung Diseases. Diagnostics (Basel) 2023; 13:2437. [PMID: 37510180 PMCID: PMC10378270 DOI: 10.3390/diagnostics13142437] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/19/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Interstitial lung diseases (ILDs) are a group of heterogeneous diseases characterized by inflammation and/or fibrosis of the lung interstitium, leading to a wide range of clinical manifestations and outcomes. Over the years, the literature has demonstrated the increased diagnostic accuracy and confidence associated with a multidisciplinary approach (MDA) in assessing diseases involving lung parenchyma. This approach was recently emphasized by the latest guidelines from the American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Latin American Thoracic Association for the diagnosis of ILDs. METHODS In this review, we will discuss the role, composition, and timing of multidisciplinary diagnosis (MDD) concerning idiopathic pulmonary fibrosis, connective tissue disease associated with ILDs, hypersensitive pneumonia, and idiopathic pneumonia with autoimmune features, based on the latest recommendations for their diagnosis. RESULTS The integration of clinical, radiological, histopathological, and, often, serological data is crucial in the early identification and management of ILDs, improving patient outcomes. Based on the recent endorsement of transbronchial cryo-biopsy in idiopathic pulmonary fibrosis guidelines, an MDA helps guide the choice of the sampling technique, obtaining the maximum diagnostic performance, and avoiding the execution of more invasive procedures such as a surgical lung biopsy. A multidisciplinary team should include pulmonologists, radiologists, pathologists, and, often, rheumatologists, being assembled regularly to achieve a consensus diagnosis and to review cases in light of new features. CONCLUSIONS The literature highlighted that an MDA is essential to improve the accuracy and reliability of ILD diagnosis, allowing for the early optimization of therapy and reducing the need for invasive procedures. The multidisciplinary diagnosis of ILDs is an ongoing and dynamic process, often referred to as a "working diagnosis", involving the progressive integration and re-evaluation of clinical, radiological, and histological features.
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Affiliation(s)
| | - Alessandro Sanduzzi Zamparelli
- Department of Clinical Medicine and Surgery, Section of Respiratory Diseases, University Federico II, Azienda Ospedaliera dei Colli-Monaldi Hospital, 80131 Naples, Italy
- Staff of UNESCO Chair for Health Education and Sustainable Development, University Federico II, 80131 Naples, Italy
| | - Marialuisa Bocchino
- Department of Clinical Medicine and Surgery, Section of Respiratory Diseases, University Federico II, Azienda Ospedaliera dei Colli-Monaldi Hospital, 80131 Naples, Italy
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Endothelin-1 as a Biomarker of Idiopathic Pulmonary Fibrosis and Interstitial Lung Disease Associated with Autoimmune Diseases. Int J Mol Sci 2023; 24:ijms24021275. [PMID: 36674789 PMCID: PMC9862125 DOI: 10.3390/ijms24021275] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
The aim of this study was to determine the role of endothelin-1 (ET-1), a molecule involved in multiple vascular and fibrosing abnormalities, as a biomarker of interstitial lung disease (ILD), as well as its use for the differential diagnosis between idiopathic pulmonary fibrosis (IPF) and ILD associated with autoimmune diseases (AD-ILD), using a large and well-defined cohort of patients with ILD. A total of 112 patients with IPF, 91 patients with AD-ILD (28 rheumatoid arthritis (RA), 26 systemic sclerosis, 20 idiopathic inflammatory myositis and 17 interstitial pneumonia with autoimmune features) and 44 healthy controls were included. ET-1 serum levels were determined by enzyme-linked immunosorbent assay. A significant increase in ET-1 levels was found in patients with IPF compared to controls. Likewise, AD-ILD patients also showed higher ET-1 levels than controls when the whole cohort was stratified by the type of AD. Similar ET-1 levels were found in IPF and AD-ILD patients, regardless of the underlying AD. Interestingly, increased ET-1 levels were correlated with worse lung function in IPF and RA-ILD patients. Our study supports that serum ET-1 may be useful as a biomarker of ILD, although it could not help in the differential diagnosis between IPF and AD-ILD. Moreover, ET-1 levels may be associated with ILD severity.
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Hoffmann T, Gassler N, Teichgräber U, Sandhaus T, Oelzner P, Wolf G, Pfeil A. Clinical Images: Severe interstitial lung disease in Sjögren disease - What happens in the lungs? Inflammation or fibrosis? ACR Open Rheumatol 2022; 5:61-62. [PMID: 36519426 PMCID: PMC9926058 DOI: 10.1002/acr2.11516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Tobias Hoffmann
- Jena University Hospital Friedrich‐Schiller‐UniversityJenaGermany
| | - Nikolaus Gassler
- Jena University Hospital Friedrich‐Schiller‐UniversityJenaGermany
| | - Ulf Teichgräber
- Jena University Hospital Friedrich‐Schiller‐UniversityJenaGermany
| | - Tim Sandhaus
- Jena University Hospital Friedrich‐Schiller‐UniversityJenaGermany
| | - Peter Oelzner
- Jena University Hospital Friedrich‐Schiller‐UniversityJenaGermany
| | - Gunter Wolf
- Jena University Hospital Friedrich‐Schiller‐UniversityJenaGermany
| | - Alexander Pfeil
- Jena University Hospital Friedrich‐Schiller‐UniversityJenaGermany
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Piotrowski WJ, Martusewicz-Boros MM, Białas AJ, Barczyk A, Batko B, Błasińska K, Boros PW, Górska K, Grzanka P, Jassem E, Jastrzębski D, Kaczyńska J, Kowal-Bielecka O, Kucharz E, Kuś J, Kuźnar-Kamińska B, Kwiatkowska B, Langfort R, Lewandowska K, Mackiewicz B, Majewski S, Makowska J, Miłkowska-Dymanowska J, Puścińska E, Siemińska A, Sobiecka M, Soroka-Dąda RA, Szołkowska M, Wiatr E, Ziora D, Śliwiński P. Guidelines of the Polish Respiratory Society on the Diagnosis and Treatment of Progressive Fibrosing Interstitial Lung Diseases Other than Idiopathic Pulmonary Fibrosis. Adv Respir Med 2022; 90:425-450. [PMID: 36285980 PMCID: PMC9717335 DOI: 10.3390/arm90050052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2023]
Abstract
The recommendations were developed as answers to previously formulated questions concerning everyday diagnostic and therapeutic challenges. They were developed based on a review of the current literature using the GRADE methodology. The experts suggest that PF-ILD be diagnosed based on a combination of different criteria, such as the aggravation of symptoms, progression of radiological lesions, and worsening of lung function test parameters. The experts recommend a precise diagnosis of an underlying disease, with serological testing for an autoimmune disease always being included. The final diagnosis should be worked out by a multidisciplinary team (MDT). Patients with an interstitial lung disease other than IPF who do not meet the criteria for the progressive fibrosis phenotype should be monitored for progression, and those with systemic autoimmune diseases should be regularly monitored for signs of interstitial lung disease. In managing patients with interstitial lung disease associated with autoimmune diseases, an opinion of an MDT should be considered. Nintedanib rather than pirfenidon should be introduced in the event of the ineffectiveness of the therapy recommended for the treatment of the underlying disease, but in some instances, it is possible to start antifibrotic treatment without earlier immunomodulatory therapy. It is also admissible to use immunomodulatory and antifibrotic drugs simultaneously. No recommendations were made for or against termination of anti-fibrotic therapy in the case of noted progression during treatment of a PF-ILD other than IPF. The experts recommend that the same principles of non-pharmacological and palliative treatment and eligibility for lung transplantation should be applied to patients with an interstitial lung disease other than IPF with progressive fibrosis as in patients with IPF.
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Affiliation(s)
| | - Magdalena M. Martusewicz-Boros
- 3rd Lung Diseases and Oncology Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Adam J. Białas
- Department of Pathobiology of Respiratory Diseases, Medical University of Lodz, 90-153 Lodz, Poland
| | - Adam Barczyk
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Bogdan Batko
- Department of Rheumatology and Immunology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, 30-705 Krakow, Poland
| | - Katarzyna Błasińska
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Piotr W. Boros
- Lung Pathophysiology Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Katarzyna Górska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Piotr Grzanka
- Department of Radiology, Voivodeship Hospital in Opole, 45-061 Opole, Poland
| | - Ewa Jassem
- Department of Allergology and Pneumonology, Medical University of Gdansk, 80-214 Gdańsk, Poland
| | - Dariusz Jastrzębski
- Department of Lung Diseases and Tuberculosis, Medical University of Silesia, 41-803 Zabrze, Poland
| | | | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Białystok, 15-276 Białystok, Poland
| | - Eugeniusz Kucharz
- Department of Internal Medicine, Rheumatology and Clinical Immunology, Medical University of Silesia, 40-635 Katowice, Poland
| | - Jan Kuś
- 1st Lung Diseases Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Barbara Kuźnar-Kamińska
- Department of Pulmonology, Allergology and Respiratory Oncology, University of Medical Sciences in Poznan, 61-701 Poznan, Poland
| | - Brygida Kwiatkowska
- Department of Rheumatology, Eleonora Reicher Rheumatology Institute, 02-637 Warszawa, Poland
| | - Renata Langfort
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warszawa, Poland
| | - Katarzyna Lewandowska
- 1st Lung Diseases Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Barbara Mackiewicz
- Department of Pneumonology, Oncology and Allergology, Medical University, Lublin, 20-090 Lublin, Poland
| | - Sebastian Majewski
- Department of Pneumology, Medical University of Lodz, 90-153 Lodz, Poland
| | - Joanna Makowska
- Department of Rheumatology, Medical University of Lodz, 92-213 Lodz, Poland
| | | | - Elżbieta Puścińska
- 2nd Department of Respiratory Medicine, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Alicja Siemińska
- Department of Allergology, Medical University of Gdańsk, 80-214 Gdansk, Poland
| | - Małgorzata Sobiecka
- 1st Lung Diseases Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | | | - Małgorzata Szołkowska
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warszawa, Poland
| | - Elżbieta Wiatr
- 3rd Lung Diseases and Oncology Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Dariusz Ziora
- Department of Lung Diseases and Tuberculosis, Medical University of Silesia, 41-803 Zabrze, Poland
| | - Paweł Śliwiński
- 2nd Department of Respiratory Medicine, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
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Cottin V, Martinez FJ, Smith V, Walsh SLF. Multidisciplinary teams in the clinical care of fibrotic interstitial lung disease: current perspectives. Eur Respir Rev 2022; 31:220003. [PMID: 38743511 DOI: 10.1183/16000617.0003-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/04/2022] [Indexed: 11/05/2022] Open
Abstract
Multidisciplinary team (MDT) meetings, involving the integrated collaboration of healthcare professionals, are increasingly used in clinical practice to inform the diagnosis and treatment of interstitial lung diseases (ILDs). Over time, the assessment of patients with ILD has transitioned from discussions among clinicians, radiologists and pathologists to the inclusion of a broader range of clinical data and specialist expertise. Studies have shown that a multidisciplinary approach can have many benefits for the clinical care of patients with ILD by improving the diagnostic confidence for different ILDs and guiding treatment decisions. The utility of MDT discussions for diagnosis, monitoring disease progression and management decisions, will need to be considered based on how it is best positioned in the diagnostic and therapeutic process, as well as the practicality and challenges of its use. There are also uncertainties and heterogeneity concerning the optimal practices of MDT meetings in ILD care. In this review, we describe recent developments refining the approach to MDTs in clinical practice, including who should be involved in the MDTs, when it is most needed, their use in patient management, challenges in their implementation, and ongoing controversies in the field that need further research.
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Affiliation(s)
- Vincent Cottin
- Louis Pradel Hospital, Reference Centre for Rare Pulmonary Diseases, Hospices Civils de Lyon, Lyon, France
- Claude Bernard University Lyon 1, UMR754, INRAE, Member of OrphaLung, RespiFil, Radico-ILD and ERN-LUNG, Lyon, France
| | | | - Vanessa Smith
- Dept of Rheumatology, Ghent University Hospital Dept of Internal Medicine, Ghent, Belgium
| | - Simon L F Walsh
- National Heart and Lung Institute, Imperial College London, London, UK
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Kallianos K. Imaging of Pulmonary Manifestations of Connective Tissue Disease. Radiol Clin North Am 2022; 60:915-924. [DOI: 10.1016/j.rcl.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Assassi S, Shao N, Yin Z, Volkmann ER, Zoz DF, Leonard TB. Understanding diagnostic pathways in systemic sclerosis and systemic sclerosis-associated interstitial lung disease: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e29993. [PMID: 35960051 PMCID: PMC9371507 DOI: 10.1097/md.0000000000029993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 01/04/2023] Open
Abstract
Systemic sclerosis-associated interstitial lung disease (SSc-ILD) is usually detected in a patient known to have SSc but may be diagnosed prior to SSc. We probed an insurance database to investigate documentation of ILD prior to SSc. Using Optum's Clinformatics® Data Mart Database, we identified patients with an SSc index date between January 1, 2010, and September 30, 2015, based on International Classification of Diseases (ICD)-9-Clinical Modification (CM) codes, ≥2 medical claims associated with SSc on different dates within 1 year, and ≥3 years of continuous enrollment prior to SSc index date (ICD-9-CM cohort). We identified an ICD-10-CM cohort comprising patients with an SSc index date between October 1, 2017, and June 30, 2019, based on ICD-10-CM codes, ≥2 medical claims associated with SSc on different dates within 1 year, and ≥2 years of continuous enrollment prior to SSc index date. ILD was defined as ≥2 medical claims associated with ILD on different dates. The ICD-9-CM and ICD-10-CM cohorts comprised 1779 and 1032 patients, respectively. In these cohorts, respectively, 7.6% and 9.3% of patients had their second medical claim associated with ILD prior to their SSc index date, and 4.3% and 5.6% of patients had their second medical claim associated with ILD >1 year prior to the SSc index date. In this analysis, 4% to 6% of patients with SSc had claims for ILD >1 year prior to a claim for SSc. These data show that SSc can affect the lung early and demonstrate the importance of screening patients with SSc for ILD and patients with ILD for SSc.
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Affiliation(s)
- Shervin Assassi
- Division of Rheumatology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Nan Shao
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Ziwei Yin
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Elizabeth R. Volkmann
- Department of Medicine, Division of Rheumatology, University of California, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Donald F. Zoz
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
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Acosta Fernández O, Aburto Barrenetxea M, Llanos González AB, Rodríguez Nieto MJ, Molina Molina M, Valenzuela C. Manejo de las enfermedades pulmonares intersticiales difusas (EPID) asociadas a enfermedades autoinmunes, por el neumólogo en las diferentes unidades de EPID en España. OPEN RESPIRATORY ARCHIVES 2022. [PMID: 37497172 PMCID: PMC10369650 DOI: 10.1016/j.opresp.2022.100160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction The aim of the study was to know the management of patients with diffuse interstitial lung disease (ILD) associated with a systemic autoimmune diseases (SAD) in pulmonology outpatient clinics in Spain. Methodology The ILD work area of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) designed a self-completed questionnaire of 25 questions, on aspects related to the diagnosis and treatment of ILD-SAD. This was distributed among the attendees of the winter meeting of the ILD Area and later via e-mail to all the members of the ILD area of SEPAR. Participation was anonymous, voluntary and without consideration. Results 74 pulmonologists from 58 hospitals participated. 77% had a specialized ILD consultation. All Units with SEPAR accreditation had a committee made up of pulmonologists and radiologists and a majority participation of pathologists and rheumatologists. In 75% of the centers there was a close collaboration with Rheumatology for the management of ILD-SAD. 85% considered that the frequency of ILD-SAD consults is increasing, the most frequent being ILD associated with rheumatoid arthritis. The treatment of ILD-SAD is decided by consensus between pulmonologist and rheumatologist in 91.3% of the cases. 67% of pulmonologists consider that immunosuppressants and biological therapies can slow down the progression of ILD-SAD. 51% use antifibrotics therapies in these pathologies. Conclusions Almost all of the accredited Spanish ILD Units by SEPAR have established collaborations with Rheumatology for the adequate management of patients with ILD-SAD, this practice having been extended to units not yet accredited.
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Mackintosh JA, Wells AU, Cottin V, Nicholson AG, Renzoni EA. Interstitial pneumonia with autoimmune features: challenges and controversies. Eur Respir Rev 2021; 30:210177. [PMID: 34937706 PMCID: PMC9488577 DOI: 10.1183/16000617.0177-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/01/2021] [Indexed: 11/05/2022] Open
Abstract
The presence of clinical, serological and/or radiological features suggestive, but not confirmatory, of a defined connective tissue disease in patients with interstitial lung disease is a relatively frequent occurrence. In 2015, the European Respiratory Society and the American Thoracic Society proposed classification criteria for the interstitial pneumonia with autoimmune features (IPAF) research entity to capture such patients in a standardised manner, with the intention of nurturing clinical research. This initiative resulted in the publication of several series of IPAF patients, with significant variation between cohorts in clinical characteristics, outcome and the application of IPAF criteria in patient selection. From this increasing body of published work, it has become apparent that revision of IPAF criteria is now required in order to justify the eventual designation of IPAF as a standalone diagnostic term, as opposed to a provisional entity put forward as a basis for clinical research. This review covers the current state of IPAF, conclusions that can and cannot be drawn from the IPAF evidence base, and ongoing uncertainties that require further expert group consideration.
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Affiliation(s)
- John A Mackintosh
- Dept of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Diseases, NHLI, Imperial College, London, UK
| | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
- Claude Bernard University Lyon 1, University of Lyon, INRAE, IVPC, UMR754, member of ERN-LUNG, Lyon, France
| | - Andrew G Nicholson
- Dept of Histopathology, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Elisabetta A Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- Margaret Turner Warwick Centre for Fibrosing Lung Diseases, NHLI, Imperial College, London, UK
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13
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Ottewill C, Aamir S, Nash D, Dunne R, Redmond K, Fabre A, Durcan L, Keogan M, Hurley K. Isolated interstitial lung disease associated with anti-Ku autoantibodies: a case responding to a CD20 inhibitor. QJM 2021; 114:258-260. [PMID: 32697838 DOI: 10.1093/qjmed/hcaa227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 06/24/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Ottewill
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - S Aamir
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - D Nash
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - R Dunne
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Radiology Department, Beaumont Hospital, Dublin, Ireland-Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - K Redmond
- Thoracic Surgery Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - A Fabre
- Department of Histopathology, St Vincent's University Hospital, Dublin, Ireland
| | - L Durcan
- Department of Rheumatology, Beaumont Hospital, Dublin, Ireland
| | - M Keogan
- Immunology Department, Beaumont Hospital, Dublin, Ireland
| | - K Hurley
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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14
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Solomon JJ, Swigris JJ, Kreuter M, Polke M, Aronson K, Hoffmann-Vold AM, Dellaripa PF. The Attitudes and Practices of Physicians Caring for Patients with Rheumatoid Arthritis-Interstitial Lung Disease: An International Survey. Rheumatology (Oxford) 2021; 61:1459-1467. [PMID: 34260687 DOI: 10.1093/rheumatology/keab552] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/05/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study sought to determine the level of understanding and opinion amongst rheumatologist and pulmonologists regarding risk factors, diagnostic approach and treatment of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). METHODS We conducted an international electronic survey of rheumatologists and pulmonologists utilizing two separate Redcap-based surveys with questions on the epidemiology, workup and management of RA-ILD as well as ILD screening questions using case-based scenarios directed at rheumatologists. The survey also collected demographic data on participants including their practice setting, years in practice and country of practice. RESULTS We received a total of 616 responses (354 rheumatologists and 262 pulmonologists) from 6 continents. There were significant differences in responses between pulmonologists and rheumatologists in estimated prevalence and mortality, risk factors for the development of ILD in RA and medications that are effective or should be avoided. Rheumatologists were much less likely to consider assessment for ILD in high risk, asymptomatic patients compared with high-risk patients with either symptoms or exam findings suggestive of ILD. CONCLUSION Our study brought to light the variability in disease assessment and clinical practice amongst providers caring for patients with RA-ILD and indicate that greater education is needed to optimize clinical decision making in the risk assessment, screening and treatment of RA-ILD. Research questions that address appropriate screening and treatment strategies for RA-ILD will be valuable for rheumatologists given their central role in the overall health and lung health of patients with RA.
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Affiliation(s)
| | | | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik University of Heidelberg, Heidelberg, Germany and German Center for Lung Research, Heidelberg, Germany
| | - Markus Polke
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik University of Heidelberg, Heidelberg, Germany and German Center for Lung Research, Heidelberg, Germany
| | - Kerri Aronson
- Department of Medicine, Weill Cornell, USA, New York, NY
| | | | - Paul F Dellaripa
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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15
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Kelly CA, Nisar M, Arthanari S, Carty S, Woodhead FA, Price-Forbes A, Middleton D, Dempsey O, Miller D, Basu N, Dawson J, Sathi N, Ahmad Y, Palmer E, Iqbal K, Janakiraman G, Koduri G, Young A. Rheumatoid arthritis related interstitial lung disease - improving outcomes over 25 years: a large multicentre UK study. Rheumatology (Oxford) 2021; 60:1882-1890. [PMID: 33150434 DOI: 10.1093/rheumatology/keaa577] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/14/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study explores whether the prognosis of interstitial lung disease in rheumatoid arthritis (RA-ILD) has improved over time and assesses the potential influence of drug therapy in a large multicentre UK network. METHODS We analysed data from 18 UK centres on patients meeting criteria for both RA and ILD diagnosed over a 25-year period. Data included age, disease duration, outcome and cause of death. We compared all cause and respiratory mortality between RA controls and RA-ILD patients, assessing the influence of specific drugs on mortality in four quartiles based on year of diagnosis. RESULTS A total of 290 RA-ILD patients were identified. All cause (respiratory) mortality was increased at 30% (18%) compared with controls 21% (7%) (P =0.02). Overall, prognosis improved over quartiles with median age at death rising from 63 years to 78 years (P =0.01). No effect on mortality was detected as a result of DMARD use in RA-ILD. Relative risk (RR) of death from any cause was increased among patients who had received anti-TNF therapy [2.09 (1.1-4.0)] P =0.03, while RR was lower in those treated with rituximab [0.52(0.1-2.1)] or mycophenolate [0.65 (0.2-2.0)]. Patients receiving rituximab as their first biologic had longer three (92%), five (82%) and seven year (80%) survival than those whose first biologic was an anti-TNF agent (82%, 76% and 64%, respectively) (P =0.037). DISCUSSION This large retrospective multicentre study demonstrates survival of patients with RA-ILD has improved. This may relate to the increasing use of specific immunosuppressive and biologic agents.
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Affiliation(s)
- Clive A Kelly
- Department of Cellular Medicine, University of Newcastle upon Tyne, Gateshead, UK
| | - Mohamed Nisar
- Rheumatology, Burton Hospitals NHS Foundation Trust, Burton on Trent, UK
| | - Suba Arthanari
- Rheumatology, Burton Hospitals NHS Foundation Trust, Burton on Trent, UK
| | - Sarah Carty
- Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Felix A Woodhead
- Chest Medicine, University Hospital Leicester NHS Foundation Trust, Leicester, UK
| | - Alex Price-Forbes
- Chest Medicine, University Hospital Leicester NHS Foundation Trust, Leicester, UK
| | | | | | | | - Neil Basu
- Rheumatology, Royal Hospital, Aberdeen, UK
| | - Julie Dawson
- Rheumatology, St Helens and Knowsley Teaching Hospitals NHS Trust, Knowsley, UK
| | - Nav Sathi
- Rheumatology, St Helens and Knowsley Teaching Hospitals NHS Trust, Knowsley, UK
| | - Yasmin Ahmad
- Rheumatology, North Wales Hospitals Trust, Betsy-Coed, UK
| | - Evelyn Palmer
- Medicine, Northern Deanery, Health Education North East, Newcastle, UK
| | - Kundan Iqbal
- Medicine, Northern Deanery, Health Education North East, Newcastle, UK
| | | | - Gouri Koduri
- Rheumatology, Southend Hospital, Westcliff-on-Sea, UK
| | - Adam Young
- Rheumatology, St Albans City Hospital, St Albans, UK
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Castelino FV, Moua T. Detection and Management of Interstitial Lung Diseases Associated With Connective Tissue Diseases. ACR Open Rheumatol 2021; 3:295-304. [PMID: 33779080 PMCID: PMC8126753 DOI: 10.1002/acr2.11253] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/26/2021] [Indexed: 01/08/2023] Open
Abstract
Interstitial lung disease (ILD) is a common manifestation of connective tissue diseases (CTDs). A proportion of patients with CTD-ILDs develop progressive fibrosing ILD, which is characterized by worsening fibrotic abnormalities on high-resolution computed tomography scan, decline in lung function, worsening symptoms, and early mortality. Here, we review the impact of ILD in patients with CTDs, the importance of prompt diagnosis and close monitoring, and the evidence available to guide the management of CTD-ILDs. Management of patients with CTD-ILDs should be individualized and involve close collaboration between rheumatologists and pulmonologists. Immunosuppression is the mainstay of therapy for CTDs, but evidence for its effectiveness in slowing the progression of ILD is limited. Recently, nintedanib has been approved to slow decline in lung function in patients with systemic sclerosis-associated ILD and chronic fibrosing ILDs with a progressive phenotype. The results of ongoing clinical trials will help clinicians take a more evidence-based approach to the treatment of CTD-ILDs.
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17
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Alevizos MK, Giles JT, Patel NM, Bernstein EJ. Risk of progression of interstitial pneumonia with autoimmune features to a systemic autoimmune rheumatic disease. Rheumatology (Oxford) 2020; 59:1233-1240. [PMID: 31550371 DOI: 10.1093/rheumatology/kez404] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/27/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine the risk of developing a systemic autoimmune rheumatic disease (ARD) after an initial diagnosis of interstitial pneumonia with autoimmune features (IPAF). METHODS We performed a retrospective cohort study of patients with interstitial lung disease (ILD) who were evaluated at Columbia University Irving Medical Center from 2009 to 2017. We divided patients with idiopathic ILD into two groups: those who met IPAF criteria and those who did not meet IPAF criteria at initial ILD diagnosis. We examined the association between IPAF and diagnosis of ARD during the follow-up period using a multivariable-adjusted logistic regression model. RESULTS Of the 697 patients with ILD who were screened, 174 met inclusion criteria (50 met IPAF criteria and 124 did not). During a median follow-up period of 5.2 years, 16% (8/50) of subjects with IPAF were diagnosed with an ARD compared with 1.6% (2/124) of subjects without IPAF (P = 0.001). Adjusting for age, sex, smoking status and use of immunosuppressive therapy, the odds of progressing to an ARD were 14 times higher in subjects with IPAF than in those without IPAF (odds ratio 14.18, 95% CI 1.44-138.95, P = 0.02). CONCLUSION The presence of IPAF confers an increased risk of developing an ARD. Patients with IPAF should therefore be followed closely for the development of an ARD.
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Affiliation(s)
- Michail K Alevizos
- Division of Rheumatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jon T Giles
- Division of Rheumatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Nina M Patel
- Division of Pulmonary and Critical Care, Columbia University Irving Medical Center, New York, NY, USA
| | - Elana J Bernstein
- Division of Rheumatology, Columbia University Irving Medical Center, New York, NY, USA
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18
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The Spectrum of Interstitial Lung Disease Associated with Autoimmune Diseases: Data of a 3.6-Year Prospective Study from a Referral Center of Interstitial Lung Disease and Lung Transplantation. J Clin Med 2020; 9:jcm9061606. [PMID: 32466389 PMCID: PMC7356573 DOI: 10.3390/jcm9061606] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/17/2022] Open
Abstract
Interstitial lung disease (ILD) may occur in patients with a rheumatic autoimmune disease (AD), increasing their risk of morbidity and mortality. However, little is known about the prevalence of AD in patients diagnosed with an ILD. In this prospective study, we determined the spectrum of ILD associated with AD (AD-ILD) among patients sent for assessment to a single clinic of ILD and lung transplantation from a referral center between May 2016 and December 2019. ILD diagnosis was made by pneumologists based on clinical and radiological findings and pulmonary function test abnormalities. All patients with ILD were also assessed by experienced rheumatologists. During the period of assessment, 338 patients were diagnosed with ILD. Among them, 32.8% fulfilled definitions for an AD. Most cases with AD-ILD had a diagnosis of rheumatoid arthritis (27.0%), systemic sclerosis (26.1%) or anti-synthetase syndrome (17.1%). Interestingly, 18% of the patients with AD-ILD were diagnosed as having an interstitial pneumonia with autoimmune features. Antinuclear antibodies and non-specific interstitial pneumonia were the most frequent positive autoantibodies and radiological pattern found in AD-ILD patients, respectively. In conclusion, our study indicates that a high number of ILD patients have a related AD. Consequently, close collaboration among rheumatologists and pneumologists is needed.
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Targeting CD20 in the treatment of interstitial lung diseases related to connective tissue diseases: A systematic review. Autoimmun Rev 2020; 19:102453. [DOI: 10.1016/j.autrev.2019.102453] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 08/15/2019] [Indexed: 12/27/2022]
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20
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Hernandez-Gonzalez F, Prieto-González S, Brito-Zeron P, Cuerpo S, Sanchez M, Ramirez J, Agustí C, Lucena CM, Paradela M, Grafia I, Espinosa G, Sellares J. Impact of a systematic evaluation of connective tissue disease on diagnosis approach in patients with interstitial lung diseases. Medicine (Baltimore) 2020; 99:e18589. [PMID: 31977850 PMCID: PMC7004576 DOI: 10.1097/md.0000000000018589] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
To date, there is no clear agreement regarding which is the best method to detect a connective tissue disease (CTD) during the initial diagnosis of interstitial lung diseases (ILD). The aim of our study was to explore the impact of a systematic diagnostic strategy to detect CTD-associated ILD (CTD-ILD) in clinical practice, and to clarify the significance of interstitial pneumonia with autoimmune features (IPAF) diagnosis in ILD patients.Consecutive patients evaluated in an ILD Diagnostic Program were divided in 3 groups: IPAF, CTD-ILD, and other ILD forms. Clinical characteristics, exhaustive serologic testing, high resolution computed tomography (HRCT) images, lung biopsy specimens, and follow-up were prospectively collected and analyzed.Among 139 patients with ILD, CTD was present in 21 (15.1%), 24 (17.3%) fulfilled IPAF criteria, and 94 (67.6%) were classified as other ILD forms. Specific systemic autoimmune symptoms such as Raynaud phenomenon (19%), inflammatory arthropathy (66.7%), and skin manifestations (38.1%) were more frequent in CTD-ILD patients than in the other groups (all P < .001). Among autoantibodies, antinuclear antibody was the most frequently found in IPAF (42%), and CTD-ILD (40%) (P = .04). Nonspecific interstitial pneumonia, detected by HRCT scan, was the most frequently seen pattern in patients with IPAF (63.5%), or CTD-ILD (57.1%) (P < .001). In multivariate analysis, a suggestive radiological pattern by HRCT scan (odds ratio [OR] 15.1, 95% confidence interval [CI] 4.7-48.3, P < .001) was the strongest independent predictor of CTD-ILD or IPAF, followed by the presence of clinical features (OR 14.6, 95% CI 4.3-49.5, P < .001), and serological features (OR 12.4, 95% CI 3.5-44.0, P < .001).This systematic diagnostic strategy was useful in discriminating an underlying CTD in patients with ILD. The defined criteria for IPAF are fulfilled by a considerable proportion of patients referred for ILD.
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Affiliation(s)
| | | | | | - Sandra Cuerpo
- Servei de Pneumologia, Hospital Clínic, IDIBAPS, Universitat de Barcelona
| | | | - Jose Ramirez
- Servicio de Anatomía Patológica, Hospital Clínic
| | - Carlos Agustí
- Servei de Pneumologia, Hospital Clínic, IDIBAPS, Universitat de Barcelona
| | | | - Marina Paradela
- Servei de Cirurgia Toràcica, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona
| | | | | | - Jacobo Sellares
- Servei de Pneumologia, Hospital Clínic, IDIBAPS, Universitat de Barcelona
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Barcelona, Spain
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21
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Furini F, Carnevale A, Casoni GL, Guerrini G, Cavagna L, Govoni M, Sciré CA. The Role of the Multidisciplinary Evaluation of Interstitial Lung Diseases: Systematic Literature Review of the Current Evidence and Future Perspectives. Front Med (Lausanne) 2019; 6:246. [PMID: 31750308 PMCID: PMC6842981 DOI: 10.3389/fmed.2019.00246] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/15/2019] [Indexed: 12/02/2022] Open
Abstract
The opportunity of a multidisciplinary evaluation for the diagnosis of interstitial pneumonias highlighted a major change in the diagnostic approach to diffuse lung disease. The new American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Latin American Thoracic Society guidelines for the diagnosis of idiopathic pulmonary fibrosis have reinforced this assumption and have underlined that the exclusion of connective tissue disease related lung involvement is mandatory, with obvious clinical and therapeutic impact. The multidisciplinary team discussion consists in a moment of interaction among the radiologist, pathologist and pulmonologist, also including the rheumatologist when considered necessary, to improve diagnostic agreement and optimize the definition of those cases in which pulmonary involvement may represent the first or prominent manifestation of an autoimmune systemic disease. Moreover, the proposal of classification criteria for interstitial lung disease with autoimmune features (IPAF) represents an effort to define lung involvement in clinically undefined autoimmune conditions. The complexity of autoimmune diseases, and in particular the lack of classification criteria defined for pathologies such as anti-synthetase syndrome, makes the involvement of the rheumatologist essential for the correct interpretation of the autoimmune element and for the application of classification criteria, that could replace clinical pictures initially interpreted as IPAF in defined autoimmune disease, minimizing the risk of misdiagnosis. The aim of this review was to evaluate the available evidence about the efficiency and efficacy of different multidisciplinary team approaches, in order to standardize the professional figures and the core set procedures that should be necessary for a correct approach in diagnosing patients with interstitial lung disease.
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Affiliation(s)
- Federica Furini
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna di Ferrara, Cona, Italy
| | - Aldo Carnevale
- Department of Radiology, Azienda Ospedaliero-Universitaria Sant'Anna di Ferrara, Cona, Italy
| | - Gian Luca Casoni
- Department of Medical Sciences, Research Centre on Asthma and COPD, University of Ferrara, Ferrara, Italy
| | - Giulio Guerrini
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna di Ferrara, Cona, Italy
| | - Lorenzo Cavagna
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Marcello Govoni
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna di Ferrara, Cona, Italy
| | - Carlo Alberto Sciré
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna di Ferrara, Cona, Italy
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22
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Fernandes L, Nasser M, Ahmad K, Cottin V. Interstitial Pneumonia With Autoimmune Features (IPAF). Front Med (Lausanne) 2019; 6:209. [PMID: 31681774 PMCID: PMC6798044 DOI: 10.3389/fmed.2019.00209] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/09/2019] [Indexed: 11/13/2022] Open
Abstract
A significant proportion of patients with interstitial lung disease (ILD) manifest autoimmune features, but do not fulfill the diagnostic criteria for a definite connective tissue disease (CTD). In 2015, the European Respiratory Society (ERS) and American Thoracic Society (ATS) “Task Force on undifferentiated Forms of connective tissue disease-associated interstitial lung disease” proposed classification criteria for a so-called research category of Interstitial Pneumonia with Autoimmune Features (IPAF). These classification criteria were based on a combination of features from three domains: a clinical domain consisting of extra-thoracic features; a serologic domain with specific autoantibodies; and a morphologic domain with imaging patterns, histopathological findings or multi-compartment involvement. Patients meeting IPAF criteria tend to have a history of smoking similar to patients with idiopathic pulmonary fibrosis. The most frequent clinical and serological markers of autoimmune features are Raynaud' phenomenon and positive antinuclear antibodies, respectively. Non-specific interstitial pneumonia is the predominant radiologic and histopathologic pattern, although patients meeting IPAF criteria through the clinical and serologic domains may also have a usual interstitial pneumonia pattern. Management should be carefully individualized on a case-by-case basis in keeping with the wide heterogeneity of IPAF and lack of evidence in this particular subgroup of patients. Prognosis is generally intermediate between that of idiopathic pulmonary fibrosis and connective tissue disease-associated interstitial lung disease, but substantially variable according to the predominant histologic and radiologic patterns. As acknowledged by the Task Force, the proposed classification scheme of IPAF is a research concept that will need revision and refinement based on data to better inform prognostication and patient care.
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Affiliation(s)
- Ligia Fernandes
- Departamento do Tórax, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Mouhamad Nasser
- Department of Respiratory Medicine, National Reference Center for Rare Pulmonary Diseases, Hospices Civils de Lyon, Lyon, France
| | - Kais Ahmad
- Department of Respiratory Medicine, National Reference Center for Rare Pulmonary Diseases, Hospices Civils de Lyon, Lyon, France
| | - Vincent Cottin
- Department of Respiratory Medicine, National Reference Center for Rare Pulmonary Diseases, Hospices Civils de Lyon, Lyon, France.,Claude Bernard Lyon 1 University, University of Lyon, INRA, UMR754, Lyon, France
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Chai GT, Tan TC, Lee YS, Kaw GJ, Chuah KL, Lim YJ, Abisheganaden JA, Thong BY. Impact of an interstitial lung disease service in the diagnosis and management of interstitial lung disease in Singapore. Singapore Med J 2019; 61:302-307. [PMID: 31317200 DOI: 10.11622/smedj.2019069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The current gold standard for diagnosing interstitial lung disease (ILD) involves an ILD clinic evaluation, followed by discussion in a multidisciplinary meeting (MDM). However, there is a paucity of data on the impact of ILD MDMs on the diagnosis and management of ILDs in Southeast Asia. We studied the clinical impact of the ILD service on the diagnosis and management of ILDs at a university-affiliated tertiary hospital in Singapore. METHODS A single-centre retrospective review was done on 97 consecutive patients referred for evaluation to the ILD service from March 2016 to August 2017. RESULTS Mean age of the patients was 67 ± 11 years. Gender distribution was almost equal (52% male), with a majority of never-smokers (63%). Mean forced vital capacity (FVC) was 1.81 ± 0.66 L (66% ± 20% predicted). The three commonest referral diagnoses were ILD of uncertain classification (n = 38, 39%), connective tissue disease-associated ILD (CTD-ILD) (n = 24, 25%) and idiopathic pulmonary fibrosis (IPF) (n = 16, 17%). Following evaluation by the ILD service, there was a change of diagnosis in 60 (62%) patients and a change of management in 71 (73%) patients. The majority of consensus MDM diagnoses were IPF (n = 35, 36%), CTD-ILD (n = 30, 30%) and others (n = 15, 15%). There was a significant prognostic separation between the IPF and non-IPF diagnoses made following evaluation by the ILD service. CONCLUSION The ILD service allowed for more precise subtyping of various ILDs. This is particularly useful for IPF patients, who can benefit from antifibrotic therapies.
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Affiliation(s)
- Gin Tsen Chai
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Teck Choon Tan
- Department of General Medicine, Khoo Teck Puat Hospital, Singapore
| | - Yeong Shyan Lee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Gregory Jl Kaw
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | | | - Yi Jing Lim
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore
| | | | - Bernard Yh Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
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Biglia C, Ghaye B, Reychler G, Koenig S, Yildiz H, Lacroix V, Tamirou F, Hoton D, Pieters T, Froidure A. Multidisciplinary management of interstitial lung diseases: A real-life study. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2019; 36:108-115. [PMID: 32476943 DOI: 10.36141/svdld.v36i2.8107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/11/2019] [Indexed: 02/01/2023]
Abstract
Background The guidelines on idiopathic pulmonary fibrosis (IPF) diagnosis established the crucial role of multidisciplinary discussion (MDD) in the diagnosis of interstitial lung diseases (ILD). However, real-life evaluation of MDD remains scarce. Our aim was to study the impact of a well-structured MDD on etiological assessment, diagnosis, and management of ILD. Methods We collected and analysed all relevant data on patients concerning diagnosis and treatment before and after MDD during the year 2017. Results One hundred fifty patients were included in the analysis. MDD had a significant impact on management: 42% of diagnoses were revised and the number of unclassifiable ILD was significantly reduced. Lung biopsy was performed in 26 patients (12 cryobiopsies and 14 surgical biopsies). The most prevalent diagnoses were connective-tissue disease associated ILD (32%), idiopathic pulmonary fibrosis (23%), hypersensitivity pneumonitis (13%) and granulomatous ILD (7%). MDD led to a change or initiation of treatment in 55% of cases. Nine patients were evaluated for transplantation, 23 patients were screened for academic or sponsored clinical trials and an 8-fold increase in rehabilitation inclusion was observed. Conclusion Our results confirm the benefits of MDD on ILD management and diagnosis. MDD also facilitates access to non-pharmacological therapies and clinical trials.
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Affiliation(s)
- Caroline Biglia
- Pneumology department, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Benoît Ghaye
- Pneumology department, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Gregory Reychler
- Pneumology department, Cliniques universitaires Saint-Luc, Bruxelles, Belgium.,Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Belgium
| | - Sandra Koenig
- Pneumology department, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Halil Yildiz
- Pneumology department, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Valérie Lacroix
- Pneumology department, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Farah Tamirou
- Pneumology department, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Delphine Hoton
- Pneumology department, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Thierry Pieters
- Pneumology department, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Antoine Froidure
- Pneumology department, Cliniques universitaires Saint-Luc, Bruxelles, Belgium.,Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Belgium
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Shappley C, Paik JJ, Saketkoo LA. Myositis-Related Interstitial Lung Diseases: Diagnostic Features, Treatment, and Complications. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019; 5:56-83. [PMID: 31984206 DOI: 10.1007/s40674-018-0110-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Courtney Shappley
- Ochsner Advanced Lung Disease Program, Ochsner Hospital Foundation, New Orleans, LA
- Tulane University Section of Pulmonary Medicine and Critical Care, New Orleans, LA
| | - Julie J Paik
- Johns Hopkins Medical Institute, Myositis Program, Baltimore, MD
| | - Lesley Ann Saketkoo
- Tulane University Section of Pulmonary Medicine and Critical Care, New Orleans, LA
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center
- University Medical Center Comprehensive Pulmonary Hypertension Center
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26
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Vivero F, Campins F, Lancellotti D, Malfante P, Babini S, Sebastiani J, Basso V, Gaser A, Enghelmayer J, Gandara E. Autoimmune interstitial lung disease in Latin-America. Clin Immunol 2019; 199:52-56. [DOI: 10.1016/j.clim.2018.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Fischer A, Strek ME, Cottin V, Dellaripa PF, Bernstein EJ, Brown KK, Danoff SK, Distler O, Hirani N, Jones KD, Khanna D, Lee JS, Lynch DA, Maher TM, Millar AB, Raghu G, Silver RM, Steen VD, Volkmann ER, Mullan RH, O'Dwyer DN, Donnelly SC. Proceedings of the American College of Rheumatology/Association of Physicians of Great Britain and Ireland Connective Tissue Disease-Associated Interstitial Lung Disease Summit: A Multidisciplinary Approach to Address Challenges and Opportunities. QJM 2019; 112:81-93. [PMID: 30605544 DOI: 10.1093/qjmed/hcy272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Indexed: 01/02/2023] Open
Affiliation(s)
- Aryeh Fischer
- From the Aryeh Fischer, MD, Joyce S. Lee, MD: University of Colorado, Denver
| | - Mary E Strek
- Mary E. Strek, MD: University of Chicago, Chicago, Illinois
| | - Vincent Cottin
- Vincent Cottin, MD: University of Lyon, UMR754, Reference Center for Rare Pulmonary Diseases, Hospices Civils de Lyon, Lyon, France
| | - Paul F Dellaripa
- Paul F. Dellaripa, MD: Brigham and Women's Hospital, Boston, Massachusetts
| | - Elana J Bernstein
- Elana J. Bernstein, MD, MSc: Columbia University Medical Center, New York, New York
| | - Kevin K Brown
- Kevin K. Brown, MD, David A. Lynch, MB, BCh: National Jewish Health, Denver, Colorado
| | - Sonye K Danoff
- Sonye K. Danoff, MD, PhD: Johns Hopkins Medicine, Baltimore, Maryland
| | - Oliver Distler
- Oliver Distler, MD: University of Zurich, Zurich, Switzerland
| | - Nik Hirani
- Nik Hirani, PhD, MRCP: Edinburgh Lung Fibrosis Clinic, NHS Lothian and Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Kirk D Jones
- Kirk D. Jones, MD: University of California, San Francisco
| | - Dinesh Khanna
- Dinesh Khanna, MD, MS, David N. O'Dwyer, MB, BCh, BAO, PhD: University of Michigan, Ann Arbor
| | - Joyce S Lee
- From the Aryeh Fischer, MD, Joyce S. Lee, MD: University of Colorado, Denver
| | - David A Lynch
- Kevin K. Brown, MD, David A. Lynch, MB, BCh: National Jewish Health, Denver, Colorado
| | - Toby M Maher
- Toby M. Maher, MD, PhD: National Heart and Lung Institute, Imperial College London and NIHR Respiratory Clinical Research Facility, Royal Brompton Hospital, London, UK
| | - Ann B Millar
- Ann B. Millar, MD: University of Bristol, Bristol, UK
| | - Ganesh Raghu
- Ganesh Raghu, MD: University of Washington, Seattle
| | - Richard M Silver
- Richard M. Silver, MD: Medical University of South Carolina, Charleston
| | | | | | - Ronan H Mullan
- Ronan H. Mullan, MBChB, Seamas C. Donnelly, MD: Trinity College, Dublin, Ireland
| | - David N O'Dwyer
- Dinesh Khanna, MD, MS, David N. O'Dwyer, MB, BCh, BAO, PhD: University of Michigan, Ann Arbor
| | - Seamas C Donnelly
- Ronan H. Mullan, MBChB, Seamas C. Donnelly, MD: Trinity College, Dublin, Ireland
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Fischer A, Strek ME, Cottin V, Dellaripa PF, Bernstein EJ, Brown KK, Danoff SK, Distler O, Hirani N, Jones KD, Khanna D, Lee JS, Lynch DA, Maher TM, Millar AB, Raghu G, Silver RM, Steen VD, Volkmann ER, Mullan RH, O'Dwyer DN, Donnelly SC. Proceedings of the American College of Rheumatology/Association of Physicians of Great Britain and Ireland Connective Tissue Disease–Associated Interstitial Lung Disease Summit: A Multidisciplinary Approach to Address Challenges and Opportunities. Arthritis Rheumatol 2019; 71:182-195. [DOI: 10.1002/art.40769] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/30/2018] [Indexed: 01/08/2023]
Affiliation(s)
| | | | - Vincent Cottin
- University of Lyon, UMR754, Reference Center for Rare Pulmonary Diseases, Hospices Civils de Lyon Lyon France
| | | | | | | | | | | | - Nik Hirani
- Edinburgh Lung Fibrosis ClinicNHS Lothian and Centre for Inflammation ResearchUniversity of Edinburgh Edinburgh UK
| | | | | | | | | | - Toby M. Maher
- National Heart and Lung Institute, Imperial College London and NIHR Respiratory Clinical Research Facility, Royal Brompton Hospital London UK
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Cotton CV, Spencer LG, New RP, Cooper RG. The utility of comprehensive autoantibody testing to differentiate connective tissue disease associated and idiopathic interstitial lung disease subgroup cases. Rheumatology (Oxford) 2017; 56:1264-1271. [PMID: 28339528 DOI: 10.1093/rheumatology/kew320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Indexed: 02/02/2023] Open
Abstract
Interstitial lung disease (ILD) comprises many heterogeneous disease groups, the largest being CTD-associated and those labelled as idiopathic out of necessity. The mechanisms causing ILD are poorly understood, but most CTD- and idiopathic-ILD cases can respond to immunosuppression, clearly suggesting a pathological role for inflammation. By contrast, corticosteroid immunosuppression causes harm without benefit in the feared idiopathic pulmonary fibrosis, suggesting that inflammation plays little pathological role, and where ILD progresses rapidly to lethal outcome even with anti-fibrotic drug use. Given the treatment response differences apparent between ILD subgroups, and the dangers and costs of corticosteroid and anti-fibrotic drug use, respectively, it has become vital in every ILD patient to make an accurate subgroup diagnosis, to optimize treatment selections. This review discusses why differentiating CTD- and idiopathic-ILD subgroup cases remains so problematic, and why existing comprehensive CTD-specific serology would, if generally available, represent an ideal biomarker tool to enhance ILD subgroup diagnostic accuracy.
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Affiliation(s)
- Caroline V Cotton
- Department of Musculoskeletal Biology II, MRC/ARUK Institute of Ageing and Chronic Disease, University of Liverpool.,University Department of Rheumatology
| | - Lisa G Spencer
- Department of Respiratory Medicine, Aintree Chest Centre, Aintree University Hospital, Liverpool, UK
| | - Robert P New
- Department of Musculoskeletal Biology II, MRC/ARUK Institute of Ageing and Chronic Disease, University of Liverpool
| | - Robert G Cooper
- Department of Musculoskeletal Biology II, MRC/ARUK Institute of Ageing and Chronic Disease, University of Liverpool.,University Department of Rheumatology
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Ananyeva LP. [Multidisciplinary problems of rheumatology and pulmonology]. TERAPEVT ARKH 2017. [PMID: 28631692 DOI: 10.17116/terarkh20178954-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Damage to the respiratory system worsens prognosis and increases mortality in all systemic immunoinflammatory rheumatic diseases (SIRDs). Leading pulmonary manifestations in each disease are different, so the typical picture of each nosological entity is very peculiar. In all SIRDs, the disease starts with lung involvement in 10-20% of cases, preceding the expanded clinical presentation of a systemic disease. At a certain stage, lung damage may be the only manifestation of the disease or predominate in its clinical picture, determining the severity of a condition. Among the patients referred to consultation with a pulmonologist for interstitial lung disease, about 15% have manifestations of SIRDs that is confirmed by a special survey. The paper discusses the diagnostic features of SIRDs with lung involvement, as well as indications for consultation with a rheumatologist. The key clinical symptoms indicating a possible rheumatic disease in patients with lung involvement are considered. Evidence for the main circulating autoantibodies identifiable in high titers in patients with SIRDs in a serological test is given and its positivity is interpreted. The issues associated with the term 'undifferentiated connective tissue diseases-associated interstitial lung disease' are discussed; the expediency of using the term 'interstitial pneumonia with autoimmune signs (AIS)' is emphasized. The clinical characteristics of and classification criteria for AIS are presented. The prognosis and outcomes of interstitial pneumonias of varying etiologies, as well as the importance of the multidisciplinary approach to managing patients with SIRDs and lung involvement, which improves the quality of diagnosis, adequacy of treatment, and quality of life, are dealt with.
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Affiliation(s)
- L P Ananyeva
- V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
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31
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Aggarwal R, McBurney C, Schneider F, Yousem SA, Gibson KF, Lindell K, Fuhrman CR, Oddis CV. Myositis-associated usual interstitial pneumonia has a better survival than idiopathic pulmonary fibrosis. Rheumatology (Oxford) 2017; 56:384-389. [PMID: 28082622 DOI: 10.1093/rheumatology/kew426] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Indexed: 12/20/2022] Open
Abstract
Objective To compare the survival outcomes between myositis-associated usual interstitial pneumonia (MA-UIP) and idiopathic pulmonary fibrosis (IPF-UIP). Methods Adult MA-UIP and IPF-UIP patients were identified using CTD and IPF registries. The MA-UIP cohort included myositis or anti-synthetase syndrome patients with interstitial lung disease while manifesting UIP on high-resolution CT chest and/or a lung biopsy revealing UIP histology. IPF subjects met American Thoracic Society criteria and similarly had UIP histopathology. Kaplan-Meier survival curves compared cumulative and pulmonary event-free survival (event = transplant or death) between (i) all MA-UIP and IPF-UIP subjects, (ii) MA-UIP with biopsy proven UIP (n = 25) vs IPF-UIP subjects matched for age, gender and baseline forced vital capacity (±10%). Cox proportional hazards ratios compared the survival controlling for co-variates. Results Eighty-one IPF-UIP and 43 MA-UIP subjects were identified. The median cumulative and event-free survival time in IPF vs MA-UIP was 5.25/1.8 years vs 16.2/10.8 years, respectively. Cumulative and event-free survival was significantly worse in IPF-UIP vs MA-UIP [hazards ratio of IPF-UIP was 2.9 (95% CI: 1.5, 5.6) and 5.0 (95% CI: 2.8, 8.7) (P < 0.001), respectively]. IPF-UIP event-free survival (but not cumulative) remained significantly worse than MA-UIP with a hazards ratio of 6.4 (95% CI: 3.0, 13.8) after controlling for age at interstitial lung disease diagnosis, gender, ethnicity and baseline forced vital capacity%. Respiratory failure was the most common cause of death in both groups. A sub-analysis of 25 biopsy-proven MA-UIP subjects showed similar results. Conclusion MA-UIP patients demonstrated a significant survival advantage over a matched IPF cohort, suggesting that despite similar histological and radiographic findings at presentation, the prognosis of MA-UIP is superior to that of IPF-UIP.
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Affiliation(s)
- Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, Department of Medicine
| | - Christine McBurney
- Division of Rheumatology and Clinical Immunology, Department of Medicine
| | | | | | - Kevin F Gibson
- Division of Pulmonary and Critical Care, Department of Medicine
| | | | - Carl R Fuhrman
- Thoracic Imaging, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chester V Oddis
- Division of Rheumatology and Clinical Immunology, Department of Medicine
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Jee AS, Adelstein S, Bleasel J, Keir GJ, Nguyen M, Sahhar J, Youssef P, Corte TJ. Role of Autoantibodies in the Diagnosis of Connective-Tissue Disease ILD (CTD-ILD) and Interstitial Pneumonia with Autoimmune Features (IPAF). J Clin Med 2017; 6:E51. [PMID: 28471413 PMCID: PMC5447942 DOI: 10.3390/jcm6050051] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 04/20/2017] [Accepted: 04/29/2017] [Indexed: 02/06/2023] Open
Abstract
The diagnosis of interstitial lung disease (ILD) requires meticulous evaluation for an underlying connective tissue disease (CTD), with major implications for prognosis and management. CTD associated ILD (CTD-ILD) occurs most commonly in the context of an established CTD, but can be the first and/or only manifestation of an occult CTD or occur in patients who have features suggestive of an autoimmune process, but not meeting diagnostic criteria for a defined CTD-recently defined as "interstitial pneumonia with autoimmune features" (IPAF). The detection of specific autoantibodies serves a critical role in the diagnosis of CTD-ILD, but there remains a lack of data to guide clinical practice including which autoantibodies should be tested on initial assessment and when or in whom serial testing should be performed. The implications of detecting autoantibodies in patients with IPAF on disease behaviour and management remain unknown. The evaluation of CTD-ILD is challenging due to the heterogeneity of presentations and types of CTD and ILD that may be encountered, and thus it is imperative that immunologic tests are interpreted in conjunction with a detailed rheumatologic history and examination and multidisciplinary collaboration between respiratory physicians, rheumatologists, immunologists, radiologists and pathologists.
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Affiliation(s)
- Adelle S Jee
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia.
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia.
| | - Stephen Adelstein
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia.
- Immunopathology Laboratory, Southwest Sydney Pathology Service, Sydney, NSW 2050, Australia.
- Department of Clinical Immunology and Allergy, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia.
| | - Jane Bleasel
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia.
- Department of Rheumatology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia.
| | - Gregory J Keir
- Department of Respiratory, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia.
| | - MaiAnh Nguyen
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia.
- Department of Clinical Immunology and Allergy, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia.
| | - Joanne Sahhar
- Department of Rheumatology, Monash Health, Clayton, VIC 3168, Australia.
- Department Medicine, Monash University, Clayton, VIC 3168, Australia.
| | - Peter Youssef
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia.
- Department of Rheumatology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia.
| | - Tamera J Corte
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia.
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia.
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Li HY, Oh YS, Choi JW, Jung JY, Jun HS. Blocking lysophosphatidic acid receptor 1 signaling inhibits diabetic nephropathy in db/db mice. Kidney Int 2017; 91:1362-1373. [PMID: 28111010 DOI: 10.1016/j.kint.2016.11.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 11/07/2016] [Accepted: 11/10/2016] [Indexed: 01/03/2023]
Abstract
Lysophosphatidic acid (LPA) is known to regulate various biological responses by binding to LPA receptors. The serum level of LPA is elevated in diabetes, but the involvement of LPA in the development of diabetes and its complications remains unknown. Therefore, we studied LPA signaling in diabetic nephropathy and the molecular mechanisms involved. The expression of autotaxin, an LPA synthesis enzyme, and LPA receptor 1 was significantly increased in both mesangial cells (SV40 MES13) maintained in high-glucose media and the kidney cortex of diabetic db/db mice. Increased urinary albumin excretion, increased glomerular tuft area and volume, and mesangial matrix expansion were observed in db/db mice and reduced by treatment with ki16425, a LPA receptor 1/3 antagonist. Transforming growth factor (TGF)β expression and Smad-2/3 phosphorylation were upregulated in SV40 MES13 cells by LPA stimulation or in the kidney cortex of db/db mice, and this was blocked by ki16425 treatment. LPA receptor 1 siRNA treatment inhibited LPA-induced TGFβ expression, whereas cells overexpressing LPA receptor 1 showed enhanced LPA-induced TGFβ expression. LPA treatment of SV40 MES13 cells increased phosphorylated glycogen synthase kinase (GSK)3β at Ser9 and induced translocation of sterol regulatory element-binding protein (SREBP)1 into the nucleus. Blocking GSK3β phosphorylation inhibited SREBP1 activation and consequently blocked LPA-induced TGFβ expression in SV40 MES13 cells. Phosphorylated GSK3β and nuclear SREBP1 accumulation were increased in the kidney cortex of db/db mice and ki16425 treatment blocked these pathways. Thus, LPA receptor 1 signaling increased TGFβ expression via GSK3β phosphorylation and SREBP1 activation, contributing to the development of diabetic nephropathy.
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Affiliation(s)
- Hui Ying Li
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, Korea; Department of Internal Medicine, Yanbian University Hospital, Yanji, Jilin Province, China
| | - Yoon Sin Oh
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, Korea; Gachon Medical Research Institute, Gil Hospital, Incheon, Korea.
| | - Ji-Woong Choi
- College of Pharmacy, Gachon University, Incheon, Korea
| | - Ji Yong Jung
- Gachon Medical Research Institute, Gil Hospital, Incheon, Korea; Division of Nephrology, Department of Internal Medicine, Gachon University School of Medicine, Incheon, Korea
| | - Hee-Sook Jun
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, Korea; Gachon Medical Research Institute, Gil Hospital, Incheon, Korea; College of Pharmacy, Gachon University, Incheon, Korea.
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Abstract
Interstitial lung disease (ILD) is a common cause of morbidity and mortality in patients with connective tissue disease (CTD). In a minority of patients the ILD may be the presenting (or only) manifestation of an underlying CTD. Diagnosis of CTD-related ILD relies on a multidisciplinary team including pulmonologists, pathologists, radiologists, and rheumatologists, as the imaging and pathologic findings may be indistinguishable from idiopathic interstitial pneumonias. Moreover, many patients with ILD are suspected of having an underlying CTD but do not meet all of the necessary criteria for a specific disorder. This article provides a pattern-based approach to the imaging of CTD-related ILD and also reviews relevant clinical, pathologic, and serologic data that radiologists should be familiar with as part of a multidisciplinary team.
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Demoruelle MK, Mittoo S, Solomon JJ. Connective tissue disease-related interstitial lung disease. Best Pract Res Clin Rheumatol 2016; 30:39-52. [PMID: 27421215 DOI: 10.1016/j.berh.2016.04.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/10/2016] [Accepted: 04/11/2016] [Indexed: 02/08/2023]
Abstract
Interstitial lung disease (ILD) is commonly present in patients with an underlying connective tissue disease (CTD), particularly those with systemic sclerosis, rheumatoid arthritis, and inflammatory myositis. The clinical spectrum can range from asymptomatic findings on imaging to respiratory failure and death. Distinguishing features in the clinical, radiographic, and histopathologic characteristics of CTD-ILD subsets can predict prognosis and treatment response. Treatment often consists of combinations of immunosuppressive medications, but there is a paucity of guidance in the literature to help clinicians determine appropriate screening and management of CTD-ILD. As such, there is a critical need for studies that can elucidate the natural history of the CTD-ILD, as well as clarify optimal therapies for CTD patients with ILD.
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Affiliation(s)
| | - Shikha Mittoo
- University of Toronto, Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Joshua J Solomon
- National Jewish Health, Division of Pulmonary and Critical Care Medicine, Denver, CO, USA.
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36
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Cottin V. Idiopathic interstitial pneumonias with connective tissue diseases features: A review. Respirology 2015. [DOI: 10.1111/resp.12588] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Vincent Cottin
- National Reference Center for Rare Pulmonary DiseasesLyon University Hospitals Lyon France
- Department of Respiratory MedicineLouis Pradel Hospital Lyon France
- Claude Bernard Lyon 1 University Lyon France
- University of Lyon; INRA Lyon France
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Fischer A, Antoniou KM, Brown KK, Cadranel J, Corte TJ, du Bois RM, Lee JS, Leslie KO, Lynch DA, Matteson EL, Mosca M, Noth I, Richeldi L, Strek ME, Swigris JJ, Wells AU, West SG, Collard HR, Cottin V. An official European Respiratory Society/American Thoracic Society research statement: interstitial pneumonia with autoimmune features. Eur Respir J 2015; 46:976-87. [DOI: 10.1183/13993003.00150-2015] [Citation(s) in RCA: 606] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/11/2015] [Indexed: 11/05/2022]
Abstract
Many patients with an idiopathic interstitial pneumonia (IIP) have clinical features that suggest an underlying autoimmune process but do not meet established criteria for a connective tissue disease (CTD). Researchers have proposed differing criteria and terms to describe these patients, and lack of consensus over nomenclature and classification limits the ability to conduct prospective studies of a uniform cohort.The “European Respiratory Society/American Thoracic Society Task Force on Undifferentiated Forms of Connective Tissue Disease-associated Interstitial Lung Disease” was formed to create consensus regarding the nomenclature and classification criteria for patients with IIP and features of autoimmunity.The task force proposes the term “interstitial pneumonia with autoimmune features” (IPAF) and offers classification criteria organised around the presence of a combination of features from three domains: a clinical domain consisting of specific extra-thoracic features, a serologic domain consisting of specific autoantibodies, and a morphologic domain consisting of specific chest imaging, histopathologic or pulmonary physiologic features.A designation of IPAF should be used to identify individuals with IIP and features suggestive of, but not definitive for, a CTD. With IPAF, a sound platform has been provided from which to launch the requisite future research investigations of a more uniform cohort.
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38
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Fischer A, Brown KK. Interstitial lung disease in undifferentiated forms of connective tissue disease. Arthritis Care Res (Hoboken) 2015; 67:4-11. [PMID: 25048539 DOI: 10.1002/acr.22394] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 07/01/2014] [Indexed: 12/14/2022]
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39
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Fischer A. Interstitial lung disease in suggestive forms of connective tissue disease. J Bras Pneumol 2014; 39:641-3. [PMID: 24473756 PMCID: PMC4075899 DOI: 10.1590/s1806-37132013000600001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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40
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Current approach to connective tissue disease-associated interstitial lung disease. Curr Opin Pulm Med 2014; 20:449-56. [DOI: 10.1097/mcp.0000000000000081] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Kelly CA, Saravanan V, Nisar M, Arthanari S, Woodhead FA, Price-Forbes AN, Dawson J, Sathi N, Ahmad Y, Koduri G, Young A. Rheumatoid arthritis-related interstitial lung disease: associations, prognostic factors and physiological and radiological characteristics--a large multicentre UK study. Rheumatology (Oxford) 2014; 53:1676-82. [PMID: 24758887 DOI: 10.1093/rheumatology/keu165] [Citation(s) in RCA: 352] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The prevalence of interstitial lung disease (ILD) in RA is ∼5%. Previous work identified increasing age, active articular disease and articular damage as risk factors for RA-associated ILD (RA-ILD). The roles of high-resolution CT (HRCT) and lung function testing in defining the nature and extent of pulmonary involvement have recently been explored. This study is the first to examine predictive and prognostic factors for the development of RA-ILD and to report on the physiological and radiological characteristics of the condition from a large multicentre UK network. METHODS We collected data from centres across the UK on patients with both RA and ILD (proved on HRCT) diagnosed over a 25-year period from 1987 to 2012 using a standard pro forma. Potential predictors of RA-ILD were analysed. Baseline lung function data were recorded and related to HRCT findings. We analysed HRCT for subtype and extent of lung involved and examined the relationship between these and both all-cause and pulmonary mortality. We compared our results with case controls matched for age and gender using computer-generated selection from the RA population from one contributing centre. RESULTS A total of 230 patients were identified from across the UK with proven RA-ILD diagnosed over 25 years. Median age at diagnosis was 64 years and the male:female ratio was 1:1.09. Univariate analysis showed anti-CCP antibody titres to be the single most strongly associated predictor of RA-ILD. Male gender, age at onset, smoking and RF were all independently associated with RA-ILD on multivariate analysis. Vital capacity (VC) was preserved in limited disease but reduced in extensive disease, while gas transfer was reduced in both. Usual interstitial pneumonia (UIP) was the most common subtype on HRCT and both this and extensive disease were associated with increased all-cause mortality. CONCLUSION This is the largest study of RA-ILD in the UK. Anti-CCP antibodies were strongly associated with RA-ILD in both sexes. Smoking was strongly associated with ILD in males, which may explain the higher frequency of RA-ILD in men. The predominant HRCT pattern was UIP and most patients had limited disease at presentation. The presence of UIP and extensive disease are associated with increased mortality. Baseline gas transfer is a useful screening tool for ILD, while the preservation of VC at baseline might predict limited disease on HRCT.
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Affiliation(s)
- Clive A Kelly
- Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK.
| | - Vadivelu Saravanan
- Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK
| | - Mohamed Nisar
- Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK
| | - Subha Arthanari
- Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK
| | - Felix A Woodhead
- Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK
| | - Alec N Price-Forbes
- Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK
| | - Julie Dawson
- Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK
| | - Navtej Sathi
- Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK
| | - Yasmeen Ahmad
- Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK
| | - Gouri Koduri
- Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK
| | - Adam Young
- Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Department of Rheumatology, Burton Hospital, Burton on Trent, Department of Chest Medicine, Coventry and Warwickshire Hospital, Coventry, Department of Rheumatology, St Helens Hospital, Department of Rheumatology, Wrightington Hospital, St Helens, Department of Rheumatology, Betsi Cadwaldr University Health Board, Llandudno and Department of Rheumatology, St Albans City Hospital, St Albans, UK
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Pereira DAS, Kawassaki ADM, Baldi BG. Interpretation of autoantibody positivity in interstitial lung disease and lung-dominant connective tissue disease. J Bras Pneumol 2013; 39:728-41. [PMID: 24473767 PMCID: PMC4075893 DOI: 10.1590/s1806-37132013000600012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 08/13/2013] [Indexed: 11/21/2022] Open
Abstract
The initial evaluation of patients with interstitial lung disease (ILD) primarily involves a comprehensive, active search for the cause. Autoantibody assays, which can suggest the presence of a rheumatic disease, are routinely performed at various referral centers. When interstitial lung involvement is the condition that allows the definitive diagnosis of connective tissue disease and the classical criteria are met, there is little debate. However, there is still debate regarding the significance, relevance, specificity, and pathophysiological role of autoimmunity in patients with predominant pulmonary involvement and only mild symptoms or formes frustes of connective tissue disease. The purpose of this article was to review the current knowledge of autoantibody positivity and to discuss its possible interpretations in patients with ILD and without clear etiologic associations, as well as to enhance the understanding of the natural history of an allegedly new disease and to describe the possible prognostic implications. We also discuss the proposition of a new term to be used in the classification of ILDs: lung-dominant connective tissue disease.
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Affiliation(s)
- Daniel Antunes Silva Pereira
- Department of Pulmonology, Instituto do Coração -
InCor, Heart Institute - University of São Paulo School of Medicine Hospital das
Clínicas, São Paulo, Brazil
| | - Alexandre de Melo Kawassaki
- Department of Pulmonology, Instituto do Câncer do
Estado de São Paulo - ICESP, São Paulo State Cancer Institute - and Pulmonologist,
Hospital Nove de Julho, São Paulo, Brazil
| | - Bruno Guedes Baldi
- Department of Pulmonology, Instituto do Coração -
InCor, Heart Institute - University of São Paulo School of Medicine Hospital das
Clínicas, São Paulo, Brazil
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Comparison of characteristics of connective tissue disease-associated interstitial lung diseases, undifferentiated connective tissue disease-associated interstitial lung diseases, and idiopathic pulmonary fibrosis in Chinese Han population: a retrospective study. Clin Dev Immunol 2013; 2013:121578. [PMID: 24171031 PMCID: PMC3792508 DOI: 10.1155/2013/121578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 08/19/2013] [Indexed: 11/18/2022]
Abstract
Our study compared the prevalence and characteristics of patients with connective tissue disease-associated interstitial lung disease (CTD-ILD), undifferentiated connective tissue disease-associated interstitial lung disease (UCTD-ILD), or idiopathic pulmonary fibrosis (IPF) between January 2009 and December 2012 in West China Hospital, western China. Patients who met the criteria for ILD were included and were assigned to CTD-ILD, UCTD-ILD, or IPF group when they met the criteria for CTD, UCTD, or IPF, respectively. Clinical characteristics, laboratory tests, and high-resolution CT images were analyzed and compared among three groups. 203 patients were included, and all were Han nationality. CTD-ILD was identified in 31%, UCTD-ILD in 32%, and IPF in 37%. Gender and age differed among groups. Pulmonary symptoms were more common in IPF, while extrapulmonary symptoms were more common in CTD-ILD and UCTD-ILD group. Patients with CTD-ILD had more abnormal antibody tests than those of UCTD-ILD and IPF. Little significance was seen in HRCT images among three groups. A systematic evaluation of symptoms and serologic tests in patients with ILD can identify CTD-ILD, UCTD-ILD, and IPF.
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Kang BH, Park JK, Roh JH, Song JW, Lee CK, Kim M, Jang SJ, Colby TV, Kim DS. Clinical significance of serum autoantibodies in idiopathic interstitial pneumonia. J Korean Med Sci 2013; 28:731-7. [PMID: 23678265 PMCID: PMC3653086 DOI: 10.3346/jkms.2013.28.5.731] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 02/28/2013] [Indexed: 11/20/2022] Open
Abstract
Although autoantibodies are routinely screened in patients with idiopathic interstitial pneumonia, there are no reliable data on their clinical usefulness. The aim of this study was to investigate the prognostic value of autoantibodies for predicting the development of new connective tissue disease in these patients and also mortality. We conducted retrospective analysis of the baseline, and follow-up data for 688 patients with idiopathic interstitial pneumonia (526 with idiopathic pulmonary fibrosis, 85 with nonspecific interstitial pneumonia, and 77 with cryptogenic organizing pneumonia) at one single tertiary referral center. The median follow-up period was 33.6 months. Antinuclear antibody was positive in 34.5% of all subjects, rheumatoid factor in 13.2%, and other specific autoantibodies were positive between 0.7%-6.8% of the cases. No significant difference in patient survival was found between the autoantibody-positive and -negative groups. However, the presence of autoantibodies, especially antinuclear antibody with a titer higher than 1:320, was a significant predictor for the future development of new connective tissue diseases (relative risk, 6.4), although the incidence was low (3.8% of all subjects during follow-up). In conclusion, autoantibodies are significant predictors for new connective tissue disease development, although they have no prognostic value.
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Affiliation(s)
- Bo Hyoung Kang
- Department of Pulmonary and Critical Care Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jin Kyeong Park
- Department of Pulmonary and Critical Care Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Hyung Roh
- Department of Pulmonary and Critical Care Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chang Keun Lee
- Department of Rheumatology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Miyoung Kim
- Department of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Se Jin Jang
- Department of Pathology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Thomas V Colby
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, USA
| | - Dong Soon Kim
- Department of Pulmonary and Critical Care Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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Alhamad EH. Interstitial lung diseases in Saudi Arabia: A single-center study. Ann Thorac Med 2013; 8:33-7. [PMID: 23440334 PMCID: PMC3573556 DOI: 10.4103/1817-1737.105717] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 11/12/2012] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND: There are relatively few epidemiological studies on interstitial lung disease (ILD) worldwide. OBJECTIVE: To report the incident cases of ILD and compare our data with reports from other populations. METHODS: Newly diagnosed ILDs were prospectively collected at a single tertiary care hospital from January 2008 to December 2011. Detailed demographic and clinical data were collected at the time of diagnosis, along with the results from diagnostic procedures, including high-resolution computed tomography (HRCT), serological tests, bronchoalveolar lavage (BAL), transbronchial lung biopsy, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and surgical lung biopsy. RESULTS: A total of 330 cases were included. The mean age was 55.4 ± 14.9 years. There was a slight predominance of females (202; 61.2%), and the male-to-female ratio was 1:1.37. The most frequent disease was connective tissue disease (CTD)-associated ILD (34.8%), followed by idiopathic pulmonary fibrosis (IPF) (23.3%), sarcoidosis (20%), and hypersensitivity pneumonitis (6.3%). Non-classifiable ILD was present in 1.8% of the total ILD cases. HRCT was performed in 97.3% of the cases, BAL in 17.5%, transbronchial lung biopsy in 21.8%, EBUS-TBNA in 4.5%, and surgical lung biopsy in 22.7% (38.6% of which were performed among the idiopathic interstitial pneumonia cases). CONCLUSIONS: CTD-ILD and IPF were the most frequently observed ILDs in this Saudi Arabian population. Similarities and differences were found with respect to the previous reports from other countries.
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Affiliation(s)
- Esam H Alhamad
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Interstitial lung disease: is interstitial lung disease the same as scleroderma lung disease? Curr Opin Rheumatol 2013; 24:656-62. [PMID: 22955020 DOI: 10.1097/bor.0b013e3283588de4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Pulmonary fibrosis is a devastating disease that affects millions of people worldwide. Among the most common forms of lung fibrosis are idiopathic pulmonary fibrosis (IPF) and scleroderma-related interstitial lung disease (SSc-ILD). Despite a wealth of literature regarding each of these diseases, studies that directly compare IPF and SSc-ILD are rare. RECENT FINDINGS This review compares the salient features of IPF and SSc-ILD. Clinical presentation and demographics will be presented, along with the newly released radiographic and pathologic criteria for IPF. Evolving concepts of pathogenesis including the role of structural cell injury, the pathogenic role of macrophages and lymphocytes, and the origin of fibroblasts are described. We conclude with new developments in the search for predictive biomarkers of disease progression, such as markers of epithelial injury, lymphocyte subsets, and circulating fibrocytes, will be presented. We conclude with a discussion of the results of recent clinical trials. SUMMARY It is found that despite differences in clinical presentation and response to treatment, similarities are noted in proposed pathogenesis and putative biomarkers. It is hoped that this information will lead to studies aimed at understanding the factors driving these difficult to treat and often deadly diseases.
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Abstract
In the last decade, significant progress has been made toward a better understanding of interstitial lung disease (ILD). A valuable tool for the clinician is high-resolution computed tomography, which aids in narrowing the differential diagnosis in patients with ILD and obviates the need for surgical lung biopsy when a usual interstitial pneumonia pattern is present. Clinicians evaluating and caring for patients with ILD need to recognize associated comorbidities. Substantial evidence shows that implementation of a multidisciplinary approach provides a high standard of care for patients, leading to improvements in the accuracy of clinical diagnosis that can significantly affect patient outcome.
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Affiliation(s)
- Esam H Alhamad
- Division of Pulmonary Medicine, College of Medicine, King Saud University, Riyadh 11461, KS, USA.
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Gan Y, Herzog EL, Gomer RH. Pirfenidone treatment of idiopathic pulmonary fibrosis. Ther Clin Risk Manag 2011; 7:39-47. [PMID: 21339942 PMCID: PMC3039013 DOI: 10.2147/tcrm.s12209] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Indexed: 12/29/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a discrete clinicopathologic entity defined by the presence of usual interstitial pneumonia on high-resolution CT scan and/or open lung biopsy and the absence of an alternate diagnosis or exposure explaining these findings. There are currently no FDA-approved therapies available to treat this disease, and the 5-year mortality is ∼80%. The pyridone derivative pirfenidone has been studied extensively as a possible therapeutic agent for use in this deadly disease. This review will present the unique clinical features and management issues encountered by physicians caring for IPF patients, including the poor response to conventional therapy. The biochemistry and preclinical efficacy of pirfenidone will be discussed along with a comprehensive review of the clinical efficacy, safety, and side effects and patient-centered foci such as quality of life and tolerability. It is hoped that this information will lend insight into the complex issues surrounding the use of pirfenidone in IPF and lead to further investigation of this agent as a possible therapy in this devastating disease.
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Affiliation(s)
- Ye Gan
- Department of Medicine, Central South University, Changsha, Hunan, China
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Song ME, Lee J, Roh SH. Impact of Rheumatologic Consultations on Detecting Interstitial Lung Disease Associated with Connective Tissue Disease. JOURNAL OF RHEUMATIC DISEASES 2011. [DOI: 10.4078/jrd.2011.18.3.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Myung-Eun Song
- Division of Rheumatology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jisoo Lee
- Division of Rheumatology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sun-Hee Roh
- Division of Rheumatology, Ewha Womans University School of Medicine, Seoul, Korea
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