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Zamora AC, Wesselius LJ, Gotway MB, Tazelaar HD, Diaz-Arumir A, Nagaraja V. Diagnostic Approach to Interstitial Lung Diseases Associated with Connective Tissue Diseases. Semin Respir Crit Care Med 2024; 45:287-304. [PMID: 38631369 DOI: 10.1055/s-0044-1785674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Interstitial lung disorders are a group of respiratory diseases characterized by interstitial compartment infiltration, varying degrees of infiltration, and fibrosis, with or without small airway involvement. Although some are idiopathic (e.g., idiopathic pulmonary fibrosis, idiopathic interstitial pneumonias, and sarcoidosis), the great majority have an underlying etiology, such as systemic autoimmune rheumatic disease (SARD, also called Connective Tissue Diseases or CTD), inhalational exposure to organic matter, medications, and rarely, genetic disorders. This review focuses on diagnostic approaches in interstitial lung diseases associated with SARDs. To make an accurate diagnosis, a multidisciplinary, personalized approach is required, with input from various specialties, including pulmonary, rheumatology, radiology, and pathology, to reach a consensus. In a minority of patients, a definitive diagnosis cannot be established. Their clinical presentations and prognosis can be variable even within subsets of SARDs.
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Affiliation(s)
- Ana C Zamora
- Division of Pulmonary and Sleep Medicine, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Lewis J Wesselius
- Division of Pulmonary and Sleep Medicine, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Michael B Gotway
- Division of Cardiothoracic Radiology, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Henry D Tazelaar
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Alejandro Diaz-Arumir
- Division of Pulmonary and Sleep Medicine, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Vivek Nagaraja
- Division of Rheumatology, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
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Mercier C, Thoreau B, Flament T, Legué S, Pearson A, Jobard S, Marchand-Adam S, Plantier L, Diot E. High Prevalence of the Lung Ultrasound Interstitial Syndrome in Systemic Sclerosis Patients with Normal HRCT and Lung Function-A Pilot Study. J Clin Med 2024; 13:2885. [PMID: 38792426 PMCID: PMC11121911 DOI: 10.3390/jcm13102885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/24/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Objective: High-resolution computed tomography (HRCT) may lack sensitivity for the early detection of interstitial lung disease associated with systemic sclerosis (SSc-ILD). Lung ultrasound is an emerging technique for the diagnosis of SSc-ILD. This cross-sectional study aimed to describe the prevalence of ultrasound interstitial syndrome in SSc patients with normal HRCT and pulmonary function tests (PFT). Methods: Thirty SSc patients with normal HRCT, FVC > 80% predicted and DLCO > 70% predicted were included. Echocardiography and PFT including impulse oscillometry and cardiopulmonary exercise testing were performed. Lung ultrasound was analyzed by two blinded operators. Patients were classified into two groups, according to the presence or absence of ultrasound interstitial syndrome, defined as the sum of B-lines in all thoracic areas ≥10 and/or pleural line thickness >3 mm on at least one thoracic area and/or a pleural line irregularity score >16%. Results: Ultrasound interstitial syndrome was present in 12 patients (40%). Inter-reader agreement for the diagnosis of ultrasound interstitial syndrome defined by the Kappa coefficient was 0.93 (95%CI 0.79-1.00). Patients with ultrasound interstitial syndrome were younger (37 years vs. 53 years, p = 0.009), more often had pitting scars (n = 7/12 vs. 3/18, p = 0.045) and had lower FVC (102 vs. 110% pred, p = 0.009), TLC (114 vs. 122% pred, p = 0.042) and low-frequency respiratory system reactance (Xrs5 Z-score 0.16 vs. 1.02, p = 0.018), while pulmonary gas exchange was similar. Conclusions: Ultrasound interstitial syndrome was detected in 12/30 SSc patients with normal HRCT and PFT. Patients with ultrasound interstitial syndrome had differences in lung function consistent with reduced respiratory compliance, suggesting minimal and/or early suspected SSc-ILD.
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Affiliation(s)
- Camille Mercier
- Service de Médecine Interne et Immunologie Clinique, Centre de Compétence Maladies Systémiques Auto-Immunes Rares, CHRU Tours, 37000 Tours, France; (S.J.); (E.D.)
| | - Benjamin Thoreau
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Auto-Immunes Rares d’Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), 75610 Paris, France;
- Institut Cochin, Inserm U1016, CNRS UMR 8104, Université Paris Cité, 75006 Paris, France
| | - Thomas Flament
- Service de Pneumologie et Explorations Fonctionnelles Respiratoires, Centre de Référence Maladies Pulmonaires Rares, CHRU Tours, 37000 Tours, France; (T.F.); (S.L.); (S.M.-A.); (L.P.)
- Lung Ultrasound Working Group (G-ECHO), Société de Pneumologie de Langue Française, Île-de-France, 75935 Paris, France
| | - Sylvie Legué
- Service de Pneumologie et Explorations Fonctionnelles Respiratoires, Centre de Référence Maladies Pulmonaires Rares, CHRU Tours, 37000 Tours, France; (T.F.); (S.L.); (S.M.-A.); (L.P.)
- Lung Ultrasound Working Group (G-ECHO), Société de Pneumologie de Langue Française, Île-de-France, 75935 Paris, France
| | | | - Stephanie Jobard
- Service de Médecine Interne et Immunologie Clinique, Centre de Compétence Maladies Systémiques Auto-Immunes Rares, CHRU Tours, 37000 Tours, France; (S.J.); (E.D.)
| | - Sylvain Marchand-Adam
- Service de Pneumologie et Explorations Fonctionnelles Respiratoires, Centre de Référence Maladies Pulmonaires Rares, CHRU Tours, 37000 Tours, France; (T.F.); (S.L.); (S.M.-A.); (L.P.)
- Centre d’Etudes des Pathologies Respiratoires (CEPR), Institut National de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR) 1100, Université de Tours, 37032 Tours, France
| | - Laurent Plantier
- Service de Pneumologie et Explorations Fonctionnelles Respiratoires, Centre de Référence Maladies Pulmonaires Rares, CHRU Tours, 37000 Tours, France; (T.F.); (S.L.); (S.M.-A.); (L.P.)
- Centre d’Etudes des Pathologies Respiratoires (CEPR), Institut National de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR) 1100, Université de Tours, 37032 Tours, France
| | - Elisabeth Diot
- Service de Médecine Interne et Immunologie Clinique, Centre de Compétence Maladies Systémiques Auto-Immunes Rares, CHRU Tours, 37000 Tours, France; (S.J.); (E.D.)
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Radić M, Novak S, Barešić M, Hećimović A, Perković D, Tekavec-Trkanjec J, Mayer M, Prus V, Morović-Vergles J, Marasović Krstulović D, Cerovec M, Bulat Kardum L, Samaržija M, Anić B. Delphi-Based Consensus on Interstitial Lung Disease Screening in Patients with Connective Tissue Diseases (Croatian National-Based Study). Biomedicines 2022; 10:biomedicines10123291. [PMID: 36552047 PMCID: PMC9775485 DOI: 10.3390/biomedicines10123291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to develop a Croatian Delphi-based expert consensus for screening interstitial lung disease (ILD) associated with connective tissue disease (CTD). A systematic literature review was conducted on risk factors for the development of ILD, prevalence and incidence of ILD, diagnostic and screening methods for ILD, and prognosis of ILD in idiopathic inflammatory myopathy (IIM), mixed connective tissue disease (MCTD), primary Sjögren's syndrome (pSS), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc) were performed. Based on the evidence found, experts developed questionnaires for screening and monitoring ILD in each CTD, which were provided via an online survey. Following the electronic survey, two screening algorithms were developed based on the consensus opinions. The detection strategy for ILD included high-resolution computed tomography (HRCT) in addition to pulmonary function testing for IIM, MCTD, and SSc. and pulmonary function testing for newly diagnosed pSS, RA and SLE. However, in patients with identified risk factors for ILD HRCT, these tests should also be performed. A screening strategy for early identification of patients with various CTD-ILD was first developed by a multidisciplinary team of rheumatologists, pulmonologists, and radiologists to identify early CTD patients at risk of ILD, a severe extra-articular manifestation of CTD.
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Affiliation(s)
- Mislav Radić
- Division of Rheumatology and Clinical Immunology, Centre of Excellence for Systemic Sclerosis Ministry of Health Republic of Croatia, University Hospital Centre Split, 21000 Split, Croatia
- School of Medicine, University of Split, 21000 Split, Croatia
- Correspondence:
| | - Srđan Novak
- Department of Rheumatology and Clinical Immunology, University Hospital Center Rijeka, 51000 Rijeka, Croatia
- School of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Marko Barešić
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University Hospital Center Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ana Hećimović
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Clinic for Respiratory Diseases, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Dijana Perković
- Division of Rheumatology and Clinical Immunology, Centre of Excellence for Systemic Sclerosis Ministry of Health Republic of Croatia, University Hospital Centre Split, 21000 Split, Croatia
- School of Medicine, University of Split, 21000 Split, Croatia
| | | | - Miroslav Mayer
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University Hospital Center Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Višnja Prus
- Department of Rheumatology, Clinical Immunology and Allergology, University Hospital Center Osijek, 31000 Osijek, Croatia
- School of Medicine, University of Osijek, 31000 Osijek, Croatia
| | - Jadranka Morović-Vergles
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, 10000 Zagreb, Croatia
| | - Daniela Marasović Krstulović
- Division of Rheumatology and Clinical Immunology, Centre of Excellence for Systemic Sclerosis Ministry of Health Republic of Croatia, University Hospital Centre Split, 21000 Split, Croatia
- School of Medicine, University of Split, 21000 Split, Croatia
| | - Mislav Cerovec
- Department for Rheumatology, Special Hospital Primamed, 10000 Zagreb, Croatia
| | - Ljiljana Bulat Kardum
- Department of Rheumatology and Clinical Immunology, University Hospital Center Rijeka, 51000 Rijeka, Croatia
- Department of Pneumonology, University Hospital Center Rijeka, 51000 Rijeka, Croatia
| | - Miroslav Samaržija
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Clinic for Respiratory Diseases, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Branimir Anić
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University Hospital Center Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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4
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Yoo H, Hino T, Hwang J, Franks TJ, Han J, Im Y, Lee HY, Chung MP, Hatabu H, Lee KS. Connective tissue disease-related interstitial lung disease (CTD-ILD) and interstitial lung abnormality (ILA): Evolving concept of CT findings, pathology and management. Eur J Radiol Open 2022; 9:100419. [PMID: 35445144 PMCID: PMC9014394 DOI: 10.1016/j.ejro.2022.100419] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/20/2022] [Accepted: 03/28/2022] [Indexed: 12/19/2022] Open
Abstract
Connective tissue diseases (CTDs) demonstrating features of interstitial lung disease (ILD) include systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), systemic sclerosis (SSc), dermatomyositis (DM) and polymyositis (PM), ankylosing spondylitis (AS), Sjogren syndrome (SS), and mixed connective tissue disease (MCTD). On histopathology of lung biopsy in CTD-related ILDs (CTD-ILDs), multi-compartment involvement is an important clue, and when present, should bring CTD to the top of the list of etiologic differential diagnoses. Diverse histologic patterns including nonspecific interstitial pneumonia (NSIP), usual interstitial pneumonia (UIP), organizing pneumonia, apical fibrosis, diffuse alveolar damage, and lymphoid interstitial pneumonia can be seen on histology in patients with CTD-ILDs. Although proportions of ILDs vary, the NSIP pattern accounts for a large proportion, especially in SSc, DM and/or PM and MCTD, followed by the UIP pattern. In RA patients, interstitial lung abnormality (ILA) is reported to occur in approximately 20–60% of individuals of which 35–45% will have progression of the CT abnormality. Subpleural distribution and greater baseline ILA involvement are risk factors associated with disease progression. Asymptomatic CTD-ILDs or ILA patients with normal lung function and without evidence of disease progression can be followed without treatment. Immunosuppressive or antifibrotic agents for symptomatic and/or fibrosing CTD-ILDs can be used in patients who require treatment.
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Yao X, Abd Hamid M, Sundaralingam A, Evans A, Karthikappallil R, Dong T, Rahman NM, Kanellakis NI. Clinical perspective and practices on pleural effusions in chronic systemic inflammatory diseases. Breathe (Sheff) 2020; 16:200203. [PMID: 33447289 PMCID: PMC7792825 DOI: 10.1183/20734735.0203-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Systemic inflammatory diseases are a heterogeneous family of autoimmune chronic inflammatory disorders that affect multiple systems within the human body. Connective tissue disease (CTD) is a large group within this family characterised by immune-mediated inflammation of the connective tissue. This group of disorders are often associated with pleural manifestations. CTD-induced pleuritis exhibits a wide variety of symptoms and signs including exudative pleural effusions and chest pain. Accurate estimation of prevalence for CTD-related pleuritis is challenging as small effusions are asymptomatic and remain undetected. Rheumatoid arthritis and systemic lupus erythematosus are frequent CTDs and present with pleural pathology in approximately 5–20% and 17–60% of cases, respectively. By contrast, pleural involvement in systemic sclerosis, eosinophilia–myalgia syndrome, mixed connective tissue disease, ankylosing spondylitis, polymyositis and dermatomyositis syndrome is rare. Clinical management depends on the severity of symptoms; however, most effusions resolve spontaneously. In this review we discuss the pathophysiological mechanisms and the clinical considerations of CTD-induced pleuritis. Chronic inflammatory diseases could cause pleural pathology. Clinical management depends on the severity of symptoms, but most effusions resolve spontaneously.https://bit.ly/333euHb
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Affiliation(s)
- Xuan Yao
- Chinese Academy of Medical Sciences Oxford Institute, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK.,Both authors contributed equally
| | - Megat Abd Hamid
- Chinese Academy of Medical Sciences Oxford Institute, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK.,Both authors contributed equally
| | - Anand Sundaralingam
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alice Evans
- Laboratory of Pleural and Lung Cancer Translational Research, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Roshan Karthikappallil
- Laboratory of Pleural and Lung Cancer Translational Research, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Tao Dong
- Chinese Academy of Medical Sciences Oxford Institute, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Laboratory of Pleural and Lung Cancer Translational Research, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Nikolaos I Kanellakis
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Laboratory of Pleural and Lung Cancer Translational Research, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.,Oxford Respiratory Trials Unit, Nuffield Dept of Medicine, University of Oxford, Oxford, UK
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6
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Yoo H, Hino T, Han J, Franks TJ, Im Y, Hatabu H, Chung MP, Lee KS. Connective tissue disease-related interstitial lung disease (CTD-ILD) and interstitial lung abnormality (ILA): Evolving concept of CT findings, pathology and management. Eur J Radiol Open 2020; 8:100311. [PMID: 33364263 PMCID: PMC7750149 DOI: 10.1016/j.ejro.2020.100311] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 01/10/2023] Open
Abstract
The connective tissue diseases (CTDs) demonstrating features of interstitial lung disease (ILD) include systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), progressive systemic sclerosis (PSS), dermatomyositis (DM) and polymyositis (PM), ankylosing spondylitis (AS), Sjogren's syndrome (SS), and mixed connective tissue disease (MCTD). In RA patients in particular, interstitial lung abnormality (ILA) (of varying degrees; severe vs. mild) is reported to occur in approximately 20-60 % of individuals and CT disease progression occurs in approximately 35-45 % of them. The ILAs have been associated with a spectrum of functional and physiologic decrement. The identification of progressive ILA may enable appropriate surveillance and the commencement of treatment with the goal of improving morbidity and mortality rates of established RA-ILD. Subpleural distribution and higher baseline ILA/ILD extent were risk factors associated with disease progression. At histopathologic analysis, connective tissue disease-related interstitial lung diseases (CTD-ILDs) are diverse and include nonspecific interstitial pneumonia (NSIP), usual interstitial pneumonia (UIP), organizing pneumonia (OP), apical fibrosis, diffuse alveolar damage (DAD), and lymphoid interstitial pneumonia (LIP). Even though proportions of ILDs vary, NSIP pattern accounts for a large proportion, especially in PSS, DM/PM and MCTD, followed by UIP pattern. Evidence has been published that treatment of subclinical CT lung abnormalities showing a tendency to progress to ILD may stabilize the CT alterations. The identification of subclinical lung abnormalities can be appropriate in the management of the disease and CT appears to be the gold standard for the evaluation of lung parenchyma.
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Key Words
- CTD, Connective tissue disease
- CTD-ILD, (Connective Tissue Disease-Related Interstitial Lung Disease)
- Connective tissue disease
- DM, Dermatomyositis
- IIP, Idiopathic interstitial pneumonia
- ILA, Interstitial lung abnormality
- ILD, Interstitial lung disease
- IPAF, Interstitial pneumonitis with autoimmune features
- IPF, Idiopathic pulmonary fibrosis
- Interstitial lung abnormality
- Interstitial lung disease
- MCTD, Mixed connective tissue disease
- NSIP, Nonspecific Interstitial Pneumonia
- OP, Organizing pneumonia
- PM, Polymyositis
- PSS, Progressive Systemic Sclerosis
- RA, Rheumatoid Arthritis
- SLE, Systemic Lupus Erythematosus
- SS, Sjogren’s Syndrome
- UCTD, Undifferentiated Connective Tissue Disease
- UIP, Usual Interstitial Pneumonia
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Affiliation(s)
- Hongseok Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Republic of Korea
| | - Takuya Hino
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 8128582, Japan
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Republic of Korea
| | - Teri J. Franks
- Pulmonary & Mediastinal Pathology, Department of Defense, The Joint Pathology Center, Silver Spring, MD, USA
| | - Yunjoo Im
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Republic of Korea
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Man Pyo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Republic of Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Republic of Korea
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TÜrk İ, CÜzdan N, ÇİftÇİ V, Arslan D, Ünal İ. Correlations Between Clinical Features and Mouth Opening in Patients With Systemic Sclerosis. Arch Rheumatol 2020; 35:196-204. [PMID: 32851368 DOI: 10.46497/archrheumatol.2020.7434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/28/2019] [Indexed: 11/03/2022] Open
Abstract
Objectives This study aims to investigate the correlations between clinical features and mouth opening in patients with systemic sclerosis (SSc). Patients and methods Eighty patients with SSc (13 males, 67 females; mean age 53.39±11.65 years; range, 31 to 76 years) followed in our clinic were enrolled in the study. Skin involvement was assessed using the modified Rodnan skin score (mRSS), joint/tendon involvement with finger-tip to palm (FTP) distance and interstitial lung disease (ILD) was evaluated with clinical and radiologic methods. The interincisal distance (ID) measurement was used to assess the maximal mouth opening capacity. We examined associations between the ID and clinical features of SSc. Results The ID was lower in females compared with males, and in diffuse type compared with the limited type (p<0.001 and p<0.001, respectively). A significant negative correlation was found between the ID with mRSS and FTP distance (p<0.001 and p=0.001, respectively). The ID was lower in patients with ILD than in patients without ILD (p=0.006). A formula was constituted to predict the maximal mouth opening of the patient with regression analysis. According to the formula, being male was associated with an increase of 6.14 mm, the presence of ILD with a decrease of 3.19 mm, every 10 mm increment in mRSS with a decrease of 3.72 mm and FTP distance >0 mm with a decrease of 5.13 mm in mouth opening. Conclusion Microstomia is associated with low quality of life in patients with SSc. In our study, sex, ILD, mRSS, and FTP distance were observed to be the most important factors that were related with mouth opening in patients with SSc.
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Affiliation(s)
- İpek TÜrk
- Department of Internal Medicine, Division of Rheumatology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Nihan CÜzdan
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Volkan ÇİftÇİ
- Department of Pediatric Dentistry, Çukurova University Faculty of Dentistry, Adana, Turkey
| | - Didem Arslan
- Department of Internal Medicine, Division of Rheumatology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - İlker Ünal
- Department of Biostatistics, Çukurova University Faculty of Medicine, Adana, Turkey
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Schaadt NS, Schönmeyer R, Forestier G, Brieu N, Braubach P, Nekolla K, Meyer-Hermann M, Feuerhake F. Graph-based description of tertiary lymphoid organs at single-cell level. PLoS Comput Biol 2020; 16:e1007385. [PMID: 32084130 PMCID: PMC7055921 DOI: 10.1371/journal.pcbi.1007385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 03/04/2020] [Accepted: 09/09/2019] [Indexed: 01/17/2023] Open
Abstract
Our aim is to complement observer-dependent approaches of immune cell evaluation in microscopy images with reproducible measures for spatial composition of lymphocytic infiltrates. Analyzing such patterns of inflammation is becoming increasingly important for therapeutic decisions, for example in transplantation medicine or cancer immunology. We developed a graph-based assessment of lymphocyte clustering in full whole slide images. Based on cell coordinates detected in the full image, a Delaunay triangulation and distance criteria are used to build neighborhood graphs. The composition of nodes and edges are used for classification, e.g. using a support vector machine. We describe the variability of these infiltrates on CD3/CD20 duplex staining in renal biopsies of long-term functioning allografts, in breast cancer cases, and in lung tissue of cystic fibrosis patients. The assessment includes automated cell detection, identification of regions of interest, and classification of lymphocytic clusters according to their degree of organization. We propose a neighborhood feature which considers the occurrence of edges with a certain type in the graph to distinguish between phenotypically different immune infiltrates. Our work addresses a medical need and provides a scalable framework that can be easily adjusted to the requirements of different research questions.
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Affiliation(s)
| | | | | | | | - Peter Braubach
- Institute for Pathology, Hannover Medical School, Hannover, Germany
| | | | - Michael Meyer-Hermann
- Systems Immunology and Integrated Centre of Systems Biology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- Institute for Biochemistry, Biotechnology and Bioinformatics, TU Braunschweig, Braunschweig, Germany
| | - Friedrich Feuerhake
- Institute for Pathology, Hannover Medical School, Hannover, Germany
- Institute for Neuropathology, University Clinic Freiburg, Freiburg, Germany
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9
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Kwon KY. Pathological interpretation of connective tissue disease-associated lung diseases. Yeungnam Univ J Med 2019; 36:8-15. [PMID: 31620606 PMCID: PMC6784620 DOI: 10.12701/yujm.2019.00101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 12/17/2022] Open
Abstract
Connective tissue diseases (CTDs) can affect all compartments of the lungs, including airways, alveoli, interstitium, vessels, and pleura. CTD-associated lung diseases (CTD-LDs) may present as diffuse lung disease or as focal lesions, and there is significant heterogeneity between the individual CTDs in their clinical and pathological manifestations. CTD-LDs may presage the clinical diagnosis a primary CTD, or it may develop in the context of an established CTD diagnosis. CTD-LDs reveal acute, chronic or mixed pattern of lung and pleural manifestations. Histopathological findings of diverse morphological changes can be present in CTD-LDs airway lesions (chronic bronchitis/bronchiolitis, follicular bronchiolitis, etc.), interstitial lung diseases (nonspecific interstitial pneumonia/fibrosis, usual interstitial pneumonia, lymphocytic interstitial pneumonia, diffuse alveolar damage, and organizing pneumonia), pleural changes (acute fibrinous or chronic fibrous pleuritis), and vascular changes (vasculitis, capillaritis, pulmonary hemorrhage, etc.). CTD patients can be exposed to various infectious diseases when taking immunosuppressive drugs. Histopathological patterns of CTD-LDs are generally nonspecific, and other diseases that can cause similar lesions in the lungs must be considered before the diagnosis of CTD-LDs. A multidisciplinary team involving pathologists, clinicians, and radiologists can adequately make a proper diagnosis of CTD-LDs.
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Affiliation(s)
- Kun Young Kwon
- Department of Pathology, Dongkang Hospital, Ulsan, Korea
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Sontake V, Kasam RK, Sinner D, Korfhagen TR, Reddy GB, White ES, Jegga AG, Madala SK. Wilms' tumor 1 drives fibroproliferation and myofibroblast transformation in severe fibrotic lung disease. JCI Insight 2018; 3:121252. [PMID: 30135315 DOI: 10.1172/jci.insight.121252] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/11/2018] [Indexed: 12/29/2022] Open
Abstract
Wilms' tumor 1 (WT1) is a critical transcriptional regulator of mesothelial cells during lung development but is downregulated in postnatal stages and adult lungs. We recently showed that WT1 is upregulated in both mesothelial cells and mesenchymal cells in the pathogenesis of idiopathic pulmonary fibrosis (IPF), a fatal fibrotic lung disease. Although WT1-positive cell accumulation leading to severe fibrotic lung disease has been studied, the role of WT1 in fibroblast activation and pulmonary fibrosis remains elusive. Here, we show that WT1 functions as a positive regulator of fibroblast activation, including fibroproliferation, myofibroblast transformation, and extracellular matrix (ECM) production. Chromatin immunoprecipitation experiments indicate that WT1 binds directly to the promoter DNA sequence of α-smooth muscle actin (αSMA) to induce myofibroblast transformation. In support, the genetic lineage tracing identifies WT1 as a key driver of mesothelial-to-myofibroblast and fibroblast-to-myofibroblast transformation. Importantly, the partial loss of WT1 was sufficient to attenuate myofibroblast accumulation and pulmonary fibrosis in vivo. Further, our coculture studies show that WT1 upregulation leads to non-cell autonomous effects on neighboring cells. Thus, our data uncovered a pathogenic role of WT1 in IPF by promoting fibroblast activation in the peripheral areas of the lung and as a target for therapeutic intervention.
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Affiliation(s)
- Vishwaraj Sontake
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Rajesh K Kasam
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Biochemistry, National Institute of Nutrition, Hyderabad, Telangana, India.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Debora Sinner
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Thomas R Korfhagen
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Geereddy B Reddy
- Department of Biochemistry, National Institute of Nutrition, Hyderabad, Telangana, India
| | - Eric S White
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Anil G Jegga
- Division of Biomedical Informatics Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Satish K Madala
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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12
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Abstract
PURPOSE OF REVIEW The present review intends to provide an overview of the diversity and complexity of pulmonary manifestations of rheumatologic diseases and gaps in knowledge to effectively manage them. RECENT FINDINGS Diffuse lung disease in children with rheumatologic diseases represents a heterogeneous group of autoimmune disorders. Despite their significant morbidity and mortality, we have limited understanding about their pathogenesis. Here, we provide an overview of the pathophysiology and current management approach of these disorders, highlighting tools which assist with diagnosis, risk stratification and therapy. In this context, we address the need to develop a standardized approach to diagnose at-risk patients with rheumatologic disease and to predict their progression and the need to develop robust studies which evaluate the factors and interventions that influence pulmonary disease outcome. SUMMARY Diffuse lung disease in children with rheumatologic diseases represents a heterogeneous group of severe autoimmune disorders. By adopting a collaborative research approach among multicenters to help diagnose, risk stratify, and understand disease progression, effective management decisions can be optimized to improve clinical outcome.
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13
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Simões D, Araújo FA, Severo M, Monjardino T, Cruz I, Carmona L, Lucas R. Patterns and Consequences of Multimorbidity in the General Population: There is No Chronic Disease Management Without Rheumatic Disease Management. Arthritis Care Res (Hoboken) 2016; 69:12-20. [PMID: 27482954 DOI: 10.1002/acr.22996] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 07/08/2016] [Accepted: 07/19/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To identify empirical model-based patterns of multimorbidity from chronic noncommunicable diseases in the general population, with a focus on the contribution of rheumatic and musculoskeletal diseases (RMDs), and to quantify their association with adverse health outcomes. METHODS Cross-sectional data from the Portuguese Fourth National Health Survey were analyzed (n = 23,754). Latent class analysis was used to identify patterns of coexistence of 11 chronic noncommunicable diseases (RMDs, diabetes mellitus, hypertension, chronic obstructive pulmonary disease, stroke, depression, myocardial infarction, cancer, osteoporosis, asthma, and renal failure). Based on the Outcome Measures in Rheumatology, filter 2.0, health outcomes included life impact, pathophysiologic manifestations, and resource use. We assessed the association between patterns and adverse health outcomes, through sex-, age-, and body mass index-adjusted prevalence ratios with 95% confidence intervals, obtained using Poisson regression. RESULTS Four patterns of chronic noncommunicable diseases co-occurrence were identified and labeled as low disease probability, cardiometabolic conditions, respiratory conditions, and RMDs and depression. RMDs were highly prevalent in patients with chronic diseases (from 38.6% in cardiometabolic conditions to 66.7% in RMDs and depression). While negative self-rated health, short-term disability, and chronic pain were more strongly associated with cardiometabolic conditions and respiratory conditions, all multimorbidity patterns were similarly associated with long-term disability, frequent health care utilization, and out-of-pocket health care expenses. CONCLUSION Our study emphasizes RMDs as a major presence in multimorbidity in the general population. All multimorbidity patterns were associated with a wide set of adverse health outcomes. Management strategies for the patient with chronic cardiometabolic, respiratory, or depressive conditions should also target RMDs.
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Affiliation(s)
- Daniela Simões
- University of Porto, Porto, Portugal, and Cooperativa de Ensino Superior Politécnico e Universitário, Gandra, Paredes, Portugal
| | | | | | | | - Ivo Cruz
- University of Porto, and ACeS Grande Porto V, Porto Ocidental, Porto, Portugal
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14
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Yeh JJ, Wang YC, Chen JH, Hsu WH. Effect of Systemic Lupus Erythematosus on the Risk of Incident Respiratory Failure: A National Cohort Study. PLoS One 2016; 11:e0163382. [PMID: 27654828 PMCID: PMC5031430 DOI: 10.1371/journal.pone.0163382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 09/06/2016] [Indexed: 02/06/2023] Open
Abstract
Purpose We conducted a nationwide cohort study to investigate the relationship between systemic lupus erythematosus (SLE) and the risk of incident respiratory failure. Methods From the National Health Insurance Research Database, we identified 11 533 patients newly diagnosed with SLE and 46 132 controls without SLE who were randomly selected through frequency-matching according to age, sex, and index year. Both cohorts were followed until the end of 2011 to measure the incidence of incident respiratory failure, which was compared between the 2 cohorts through a Cox proportional hazards regression analysis. Results The adjusted hazard ratio (aHR) of incident respiratory failure was 5.80 (95% confidence interval [CI] = 5.15–6.52) for the SLE cohort after we adjusted for sex, age, and comorbidities. Both men (aHR = 3.44, 95% CI = 2.67–4.43) and women (aHR = 6.79, 95% CI = 5.93–7.77) had a significantly higher rate of incident respiratory failure in the SLE cohort than in the non-SLE cohort. Both men and women aged <35 years (aHR = 31.2, 95% CI = 21.6–45.2), 35–65 years; (aHR = 6.19, 95% CI = 5.09–7.54) and ≥65 years (aHR = 2.35, 95% CI = 1.92–2.87) had a higher risk of incident respiratory failure in the SLE cohort. Moreover, the risk of incident respiratory failure was higher in the SLE cohort than the non-SLE cohort, for subjects with (aHR = 2.65, 95% CI = 2.22–3.15) or without (aHR = 9.08, 95% CI = 7.72–10.7) pre-existing comorbidities. In the SLE cohort, subjects with >24 outpatient visits and hospitalizations per year had a higher incident respiratory failure risk (aHR = 21.7, 95% CI = 18.0–26.1) compared with the non-SLE cohort. Conclusion Patients with SLE are associated with an increased risk of incident respiratory failure, regardless of their age, sex, and pre-existing comorbidities; especially medical services with higher frequency.
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Affiliation(s)
- Jun-Jun Yeh
- Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- Meiho University, Pingtung, Taiwan
| | - Yu-Chiao Wang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Jiunn-Horng Chen
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Rheumatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wu-Huei Hsu
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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15
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Larsen BT, Smith ML, Elicker BM, Fernandez JM, de Morvil GAAO, Pereira CAC, Leslie KO. Diagnostic Approach to Advanced Fibrotic Interstitial Lung Disease: Bringing Together Clinical, Radiologic, and Histologic Clues. Arch Pathol Lab Med 2016; 141:901-915. [DOI: 10.5858/arpa.2016-0299-sa] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Idiopathic pulmonary fibrosis (IPF) is a distinctive clinicopathologic entity and the most common form of progressive diffuse lung scarring in older adults. Idiopathic pulmonary fibrosis manifests histopathologically as the usual interstitial pneumonia pattern. The usual interstitial pneumonia pattern is distinguished by geographically and temporally heterogeneous fibrosis that is peripherally accentuated, often with honeycombing and traction bronchiectasis. Idiopathic pulmonary fibrosis is not the only disease that leads to end-stage lung fibrosis, however, and several other entities may also cause advanced fibrosis. Surgical lung biopsies often present a diagnostic dilemma when they show clear evidence of advanced fibrosis, but the clinical, imaging, and/or histopathologic subcharacteristics suggest something other than IPF.
Objective.—
To address this dilemma, we review several other fibrotic lung diseases, including connective tissue disease–associated interstitial lung disease, chronic hypersensitivity pneumonitis, advanced pulmonary Langerhans cell histiocytosis, end-stage pulmonary sarcoidosis, Erdheim-Chester disease, Hermansky-Pudlak syndrome, and others, detailing their clinical, radiologic, and histopathologic attributes and emphasizing similarities to and differences from IPF.
Data Sources.—
Data sources comprised published peer-reviewed literature and personal experience of the authors.
Conclusions.—
Often, clues in the lung biopsy may offer the first suggestion of a fibrotic lung disease other than IPF, and accurate classification is important for prognosis, treatment, and the development of future therapies.
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Affiliation(s)
| | | | | | | | | | | | - Kevin O. Leslie
- From the Department of Laboratory Medicine & Pathology (Drs Larsen, Smith, and Leslie), Mayo Clinic, Scottsdale, Arizona; the Department of Radiology (Dr Elicker), University of California, San Francisco; Juan Max Boettner Hospital (Drs Fernandez and Arbo-Oze de Morvil), Asunción, Paraguay; and the Department of Medicine (Dr Pereira), Federal University of São Paulo, São Paulo, Brazil
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Sperandeo M, Carnevale V, Arcangela Grimaldi M. Chest Ultrasonography as a Screening Tool for High-Resolution Computed Tomography Referral in Patients With Systemic Sclerosis-A Future Perspective: Comment on the Article by Suliman et al. Arthritis Rheumatol 2016; 68:2345-6. [DOI: 10.1002/art.39779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 06/01/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Marco Sperandeo
- IRCCS Casa Sollievo della Sofferenza Hospital; San Giovanni Rotondo Italy
| | - Vincenzo Carnevale
- IRCCS Casa Sollievo della Sofferenza Hospital; San Giovanni Rotondo Italy
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17
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Abstract
PURPOSE OF REVIEW Recent discoveries implicate the lungs as a possible extra-articular mucosal site for initiating rheumatoid arthritis-associated immunity. RECENT FINDINGS Individuals at risk for developing arthritis and patients with early untreated rheumatoid arthritis show signs of lung involvement on high-resolution computer tomography. Rheumatoid arthritis-associated antibodies are present in patients with respiratory complains such as bronchiectasis and unexplained dyspnea even in the absence of joint disease and might predict future development of rheumatoid arthritis in these patients. Rheumatoid arthritis-associated antibodies are detected in the sputum of individuals at risk for developing rheumatoid arthritis but not yet having disease. Signs of bronchial mucosal inflammation with germinal center formation and local production of antibodies have been described in patients with early untreated rheumatoid arthritis. Shared antigenic targets have been identified and characterized in the lungs and joints of rheumatoid arthritis patients. SUMMARY Recent findings support an important role for the lung as a mucosal extra-articular place were inflammation induced by external triggers (such as smoking) leads to tolerance break and generation of rheumatoid arthritis-specific immunity already before disease onset with only secondary targeting of the joints.
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Nonspecific elevation of serum Aspergillus galactomannan antigen levels in patients with rheumatoid arthritis. Respir Investig 2015; 54:44-9. [PMID: 26718144 DOI: 10.1016/j.resinv.2015.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 08/05/2015] [Accepted: 08/06/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Infections are an important cause of morbidity and mortality in patients with rheumatoid arthritis. Patients receiving immunosuppressive or anti-tumor necrosis factor (TNF) agents are vulnerable to fungal infections, including those derived from Aspergillus species. Detection of the Aspergillus galactomannan antigen in serum is useful for the early diagnosis of invasive aspergillosis in patients with hematological malignancies. However, its usefulness for detecting early invasive aspergillosis in rheumatoid arthritis patients remains unestablished. METHODS Galactomannan antigen levels were measured in 340 patients (311 female patients). For patients who exhibited galactomannan antigen levels ≥0.5 during the initial examination, a second examination was performed 3-6 months later. Conventional blood tests and chest radiography were also performed. RESULTS Elevated galactomannan antigen levels (≥0.5) were observed in 62 (18.2%) of 340 patients during the initial examination. A second examination was performed in 56 of 62 patients, 50 of whom exhibited elevated antigen levels. Elevated antigen levels were not associated with the use of any drug including anti-TNF agents. Serum galactomannan antigen levels were correlated with the albumin/globulin ratio (r=-0.19, p<0.001), γ-globulin (%; r=0.17, p=0.001), and hemoglobin concentration (r=-0.15, p=0.005). No patient was clinically diagnosed with invasive aspergillosis during the study period. CONCLUSIONS Serum galactomannan antigen levels are frequently elevated in a nonspecific manner in patients with rheumatoid arthritis.
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19
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Sontake V, Shanmukhappa SK, DiPasquale BA, Reddy GB, Medvedovic M, Hardie WD, White ES, Madala SK. Fibrocytes Regulate Wilms Tumor 1-Positive Cell Accumulation in Severe Fibrotic Lung Disease. THE JOURNAL OF IMMUNOLOGY 2015; 195:3978-91. [PMID: 26371248 DOI: 10.4049/jimmunol.1500963] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 08/04/2015] [Indexed: 02/06/2023]
Abstract
Collagen-producing myofibroblast transdifferentiation is considered a crucial determinant in the formation of scar tissue in the lungs of patients with idiopathic pulmonary fibrosis. Multiple resident pulmonary cell types and bone marrow-derived fibrocytes have been implicated as contributors to fibrotic lesions because of the transdifferentiation potential of these cells into myofibroblasts. In this study, we assessed the expression of Wilms tumor 1 (WT1), a known marker of mesothelial cells, in various cell types in normal and fibrotic lungs. We demonstrate that WT1 is expressed by both mesothelial and mesenchymal cells in idiopathic pulmonary fibrosis lungs but has limited or no expression in normal human lungs. We also demonstrate that WT1(+) cells accumulate in fibrotic lung lesions, using two different mouse models of pulmonary fibrosis and WT1 promoter-driven fluorescent reporter mice. Reconstitution of bone marrow cells into a TGF-α transgenic mouse model demonstrated that fibrocytes do not transform into WT1(+) mesenchymal cells, but they do augment accumulation of WT1(+) cells in severe fibrotic lung disease. Importantly, the number of WT1(+) cells in fibrotic lesions was correlated with severity of lung disease as assessed by changes in lung function, histology, and hydroxyproline levels in mice. Finally, inhibition of WT1 expression was sufficient to attenuate collagen and other extracellular matrix gene production by mesenchymal cells from both murine and human fibrotic lungs. Thus, the results of this study demonstrate a novel association between fibrocyte-driven WT1(+) cell accumulation and severe fibrotic lung disease.
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Affiliation(s)
- Vishwaraj Sontake
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229; Department of Biochemistry, National Institute of Nutrition, Hyderabad 500007, India
| | - Shiva K Shanmukhappa
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229
| | - Betsy A DiPasquale
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229
| | - Geereddy B Reddy
- Department of Biochemistry, National Institute of Nutrition, Hyderabad 500007, India
| | - Mario Medvedovic
- Laboratory for Statistical Genomics and Systems Biology, University of Cincinnati, Cincinnati, OH 45267; and
| | - William D Hardie
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229
| | - Eric S White
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI 48109
| | - Satish K Madala
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229;
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20
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Sperandeo M, De Cata A, Molinaro F, Trovato FM, Catalano D, Simeone A, Varriale A, Martines GF, Trovato G. Ultrasound signs of pulmonary fibrosis in systemic sclerosis as timely indicators for chest computed tomography. Scand J Rheumatol 2015; 44:389-98. [PMID: 26099251 DOI: 10.3109/03009742.2015.1011228] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Systemic sclerosis (SSc) patients in the early stages of pulmonary fibrosis (PF) often have few or no symptoms, normal to borderline pulmonary function tests, and negative chest X-ray (CXR); high-resolution computed tomography (HRCT) is the only reliable means of detecting the early signs of PF. However, thoracic ultrasound (TUS) enables detection of pleural thickening, pleural/subpleural nodules, and other subpleural lung abnormalities across 70% of the subpleural surface. We reassessed concordance between TUS abnormalities and HRCT findings in SSc patients, to see whether TUS pleural line thickness (normally <3.0 mm) could be used to earmark those with asymptomatic PF for timely HRCT assessment. METHOD In total, 175 SSc patients (nine males, 166 females), aged 46.46±15.33 years, were given CXR, TUS, HRCT, echocardiography, and pulmonary function tests. RESULTS In the 26 patients without HRCT signs of PF, pleural line thickness was ≤3.0 mm. In diffuse SSc, 97/137 patients showed pleural line thickening (between 3.0 and 5 mm) and subpleural nodules in 32/97; and 35/137 showed major pleural line thickening (≥5.0 mm) with nodules, with good concordance with HRCT patterns indicating lung fibrosis severity. HRCT was normal in 5/137, with pleural line thickness≤3.0 mm. CONCLUSIONS TUS imaging of pleural/subpleural structures can detect ultrasonographic signs of initial PF prior to the onset of respiratory symptoms and function test abnormalities and, together with current criteria, could thereby enable exclusion of PF in SSc patients. Indicating some patients for selective referral to HRCT can thereby delay unwarranted procedures, provided that pulmonary function and TUS images are stable.
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Affiliation(s)
- M Sperandeo
- a Departments of Internal Medicine and Radiology , IRCCS Casa Sollievo della Sofferenza , San Giovanni Rotondo , Italy
| | - A De Cata
- a Departments of Internal Medicine and Radiology , IRCCS Casa Sollievo della Sofferenza , San Giovanni Rotondo , Italy
| | - F Molinaro
- a Departments of Internal Medicine and Radiology , IRCCS Casa Sollievo della Sofferenza , San Giovanni Rotondo , Italy
| | - F M Trovato
- b Department of Medical and Paediatric Sciences , University of Catania , Italy
| | - D Catalano
- b Department of Medical and Paediatric Sciences , University of Catania , Italy
| | - A Simeone
- a Departments of Internal Medicine and Radiology , IRCCS Casa Sollievo della Sofferenza , San Giovanni Rotondo , Italy
| | - A Varriale
- a Departments of Internal Medicine and Radiology , IRCCS Casa Sollievo della Sofferenza , San Giovanni Rotondo , Italy
| | - G F Martines
- b Department of Medical and Paediatric Sciences , University of Catania , Italy
| | - G Trovato
- b Department of Medical and Paediatric Sciences , University of Catania , Italy
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Mutsaers SE, Birnie K, Lansley S, Herrick SE, Lim CB, Prêle CM. Mesothelial cells in tissue repair and fibrosis. Front Pharmacol 2015; 6:113. [PMID: 26106328 PMCID: PMC4460327 DOI: 10.3389/fphar.2015.00113] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/12/2015] [Indexed: 12/21/2022] Open
Abstract
Mesothelial cells are fundamental to the maintenance of serosal integrity and homeostasis and play a critical role in normal serosal repair following injury. However, when normal repair mechanisms breakdown, mesothelial cells take on a profibrotic role, secreting inflammatory, and profibrotic mediators, differentiating and migrating into the injured tissues where they contribute to fibrogenesis. The development of new molecular and cell tracking techniques has made it possible to examine the origin of fibrotic cells within damaged tissues and to elucidate the roles they play in inflammation and fibrosis. In addition to secreting proinflammatory mediators and contributing to both coagulation and fibrinolysis, mesothelial cells undergo mesothelial-to-mesenchymal transition, a process analogous to epithelial-to-mesenchymal transition, and become fibrogenic cells. Fibrogenic mesothelial cells have now been identified in tissues where they have not previously been thought to occur, such as within the parenchyma of the fibrotic lung. These findings show a direct role for mesothelial cells in fibrogenesis and open therapeutic strategies to prevent or reverse the fibrotic process.
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Affiliation(s)
- Steven E Mutsaers
- Centre for Cell Therapy and Regenerative Medicine, School of Medicine and Pharmacology, University of Western Australia and Harry Perkins Institute of Medical Research , Nedlands, WA, Australia ; Institute for Respiratory Health, Centre for Asthma, Allergy and Respiratory Research, School of Medicine and Pharmacology, University of Western Australia , Nedlands, WA, Australia
| | - Kimberly Birnie
- Institute for Respiratory Health, Centre for Asthma, Allergy and Respiratory Research, School of Medicine and Pharmacology, University of Western Australia , Nedlands, WA, Australia
| | - Sally Lansley
- Institute for Respiratory Health, Centre for Asthma, Allergy and Respiratory Research, School of Medicine and Pharmacology, University of Western Australia , Nedlands, WA, Australia
| | - Sarah E Herrick
- Institute of Inflammation and Repair, Faculty of Medical and Human Sciences and Manchester Academic Health Science Centre, University of Manchester , Manchester, UK
| | - Chuan-Bian Lim
- Centre for Cell Therapy and Regenerative Medicine, School of Medicine and Pharmacology, University of Western Australia and Harry Perkins Institute of Medical Research , Nedlands, WA, Australia ; Institute for Respiratory Health, Centre for Asthma, Allergy and Respiratory Research, School of Medicine and Pharmacology, University of Western Australia , Nedlands, WA, Australia
| | - Cecilia M Prêle
- Centre for Cell Therapy and Regenerative Medicine, School of Medicine and Pharmacology, University of Western Australia and Harry Perkins Institute of Medical Research , Nedlands, WA, Australia ; Institute for Respiratory Health, Centre for Asthma, Allergy and Respiratory Research, School of Medicine and Pharmacology, University of Western Australia , Nedlands, WA, Australia
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22
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Abstract
The pathologic correlates of interstitial lung disease (ILD) secondary to connective tissue disease (CTD) comprise a diverse group of histologic patterns. Lung biopsies in patients with CTD-associated ILD tend to demonstrate simultaneous involvement of multiple anatomic compartments of the lung. Certain histologic patterns tend to predominate in each defined CTD, and it is possible in many cases to confirm connective tissue-associated lung disease and guide patient management using surgical lung biopsy. This article will cover the pulmonary pathologies seen in rheumatoid arthritis, systemic sclerosis, myositis, systemic lupus erythematosus, Sjögren syndrome, and mixed CTD.
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Schneider F, Aggarwal R, Bi D, Gibson K, Oddis C, Yousem SA. The Pulmonary Histopathology of Anti-KS Transfer RNA Synthetase Syndrome. Arch Pathol Lab Med 2015; 139:122-5. [DOI: 10.5858/arpa.2013-0667-oa] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context
The clinical spectrum of the antisynthetase syndromes (AS) has been poorly defined, although some frequently present with pulmonary manifestations. The anti-KS anti–asparaginyl-transfer RNA synthetase syndrome is one in which pulmonary interstitial lung disease is almost always present and yet the histopathologic spectrum is not well described.
Objective
To define the morphologic manifestations of pulmonary disease in those patients with anti-KS antiasparaginyl syndrome.
Design
We reviewed the connective tissue disorder registry of the University of Pittsburgh and identified those patients with anti-KS autoantibodies who presented with interstitial lung disease and had surgical lung biopsies.
Results
The 5 patients with anti-KS antisynthetase syndrome were usually women presenting with dyspnea and without myositis, but with mechanic's hands (60%) and Raynaud phenomenon (40%). They most often presented with a usual interstitial pneumonia pattern of fibrosis (80%), with the final patient displaying organizing pneumonia.
Conclusions
Pulmonary interstitial lung disease is a common presentation in patients with the anti-KS–antisynthetase syndrome, who are often women with rather subtle or subclinical connective tissue disease, whereas the literature emphasizes the nonspecific interstitial pneumonia pattern often diagnosed clinically. Usual interstitial pneumonia and organizing pneumonia patterns of interstitial injury need to be added to this clinical differential diagnosis.
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Affiliation(s)
- Frank Schneider
- From the Departments of Pathology (Drs Schneider and Yousem, Mr Bi), Rheumatology (Drs Aggarwal and Oddis), and Pulmonary Medicine (Dr Gibson), UPMC Presbyterian, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rohit Aggarwal
- From the Departments of Pathology (Drs Schneider and Yousem, Mr Bi), Rheumatology (Drs Aggarwal and Oddis), and Pulmonary Medicine (Dr Gibson), UPMC Presbyterian, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David Bi
- From the Departments of Pathology (Drs Schneider and Yousem, Mr Bi), Rheumatology (Drs Aggarwal and Oddis), and Pulmonary Medicine (Dr Gibson), UPMC Presbyterian, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kevin Gibson
- From the Departments of Pathology (Drs Schneider and Yousem, Mr Bi), Rheumatology (Drs Aggarwal and Oddis), and Pulmonary Medicine (Dr Gibson), UPMC Presbyterian, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Chester Oddis
- From the Departments of Pathology (Drs Schneider and Yousem, Mr Bi), Rheumatology (Drs Aggarwal and Oddis), and Pulmonary Medicine (Dr Gibson), UPMC Presbyterian, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Samuel A. Yousem
- From the Departments of Pathology (Drs Schneider and Yousem, Mr Bi), Rheumatology (Drs Aggarwal and Oddis), and Pulmonary Medicine (Dr Gibson), UPMC Presbyterian, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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24
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Westhoff M. [Acute on chronic respiratory failure in interstitial pneumonias]. Med Klin Intensivmed Notfmed 2014; 110:188-96. [PMID: 25125234 DOI: 10.1007/s00063-014-0388-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/20/2014] [Accepted: 05/11/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acute exacerbations of idiopathic interstitial pneumonias and exacerbations of pleuropulmonary disease in connective tissue diseases are associated with a high mortality. DIAGNOSTIC PROCEDURES They have to be differentiated from respiratory failure in patients with interstitial lung disease as a result of infections, pulmonary embolism, cardiac failure and drug toxicity, because the latter can be treated causally. The extent and the invasivity of diagnostic procedures have to be adopted to the patient's situation. A rapid diagnosis is important in order to initiate therapies (antibiotics, anticoagulation, immunosuppression) in treatable causes of exacerbations. IMPORTANCE OF VENTILATION The prognosis for patients who are under invasive mechanical ventilation in acute exacerbations of interstitial lung disease is poor. Especially in acute exacerbations of idiopathic pulmonary fibrosis (IPF), there is no general recommendation for either invasive or for noninvasive ventilation. In acute exacerbations of other subtypes of interstitial pneumonia, either idiopathic or as a pulmonary manifestation of connective tissue disease, and in all secondary exacerbations of idiopathic interstitial pneumonias which offer further treatment options, the decision about mechanical ventilation requires a differentiated assessment. LUNG TRANSPLANTATION In younger patients with interstitial lung disease and a progressive disease, indication for lung transplantation should be made early and before an exacerbation. If patients listed for lung transplantation experience an acute exacerbation, bridging-to-transplant has to be discussed with the transplant unit. In cases without further causal treatment options palliative care must be initiated.
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Affiliation(s)
- M Westhoff
- Klinik für Pneumologie, Schlaf- und Beatmungsmedizin, Lungenklinik Hemer - Zentrum für Pneumologie und Thoraxchirurgie, Theo-Funccius-Str. 1, 58675, Hemer, Deutschland,
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Smith M, Dalurzo M, Panse P, Parish J, Leslie K. Usual interstitial pneumonia-pattern fibrosis in surgical lung biopsies. Clinical, radiological and histopathological clues to aetiology. J Clin Pathol 2013; 66:896-903. [PMID: 23703852 PMCID: PMC3786616 DOI: 10.1136/jclinpath-2013-201442] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Pulmonary fibrosis in surgical lung biopsies is said to have a 'usual interstitial pneumonia-pattern' (UIP-pattern) of disease when scarring of the parenchyma is present in a patchy, 'temporally heterogeneous' distribution. These biopsies are one of the more common non-neoplastic specimens surgical pathologists encounter and often pose a number of challenges. UIP is the expected histopathological pattern in patients with clinical idiopathic pulmonary fibrosis (IPF), but the UIP-pattern can be seen in other conditions on occasion. Most important among these are the rheumatic interstitial lung diseases (RILD) and chronic hypersensitivity pneumonitis (CHrHP). Because theses entities have different mechanisms of injury, approach to therapy, and expected clinical progression, it is imperative for the surgical pathologist to correctly classify them. Taken in isolation, the UIP-pattern seen in patients with IPF may appear to overlap with that of RILD and CHrHP, at least when using the broadest definition of this term (patchy fibrosis). However, important distinguishing features are nearly always present in our experience, and the addition of a multidisciplinary approach will often resolve the critical differences between these diseases. In this manuscript, we review the distinguishing clinical, radiologic and histopathological features of UIP of IPF, RILD and CHrHP, based, in part, on the existing literature, but also lessons learned from a busy lung biopsy consultation practice.
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Affiliation(s)
- Maxwell Smith
- Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, , Scottsdale, Arizona, USA
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Yachoui R, Ward C, Kreidy M. A rheumatoid nodule in an unusual location: mediastinal lymph node. BMJ Case Rep 2013; 2013:bcr-2013-009516. [PMID: 23645652 DOI: 10.1136/bcr-2013-009516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Rheumatoid arthritis (RA) is a multisystem inflammatory disease characterised by destructive synovitis and varied extra-articular involvement. Rheumatoid lung nodules are the most common pulmonary manifestations of RA. Rheumatoid nodules in mediastinal lymph nodes are extremely uncommon. We describe a male patient with long-standing RA and subcutaneous rheumatoid nodules presenting with multiple lung nodules and mediastinal lymphadenopathies. Definite histopathology of a lymph node was consistent with necrobiotic granuloma due to RA. Clinicians should be aware of rheumatoid nodules as a potential cause of mediastinal lymphadenopathies, mainly in advanced rheumatoid arthritis.
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Affiliation(s)
- Ralph Yachoui
- Department of Rheumatology, Cooper Medical School of Rowan University, Camden, New Jersey, USA.
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Salimbene I, Leli I, Valente S. Respiratory failure in a patient with dermatomyositis. Multidiscip Respir Med 2013; 8:27. [PMID: 23531196 PMCID: PMC3620045 DOI: 10.1186/2049-6958-8-27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 02/18/2013] [Indexed: 12/03/2022] Open
Abstract
Since its original description in 1956 the association between interstitial lung disease and polymyositis (PM) and dermatomyositis (DM) has become well established. Interstitial lung disease (ILD) can be a significant complication in rheumatic diseases (RDs). Although most patients with RD do not develop clinically evident ILD, these systemic autoimmune disorders are estimated to be responsible for approximately 25% of all ILD deaths and 2% of deaths due to all respiratory causes. Radiologic abnormalities in DM are characterized by a high incidence of airspace consolidation. Non-Specific Interstitial Pneumonia (NSIP) is the most common form of lung disease, with a frequency in biopsies 4-fold greater than that of Usual Interstitial Pneumonia (UIP) in PM and a slightly smaller predominance in DM. We report a case of a female patient, 57 years old, no former smoker, whose clinical history was onset in November 2008 with asthenia with muscle and osteoarticular pain especially located in the upper limbs and then also expanded to the lower limbs. The EMG was compatible with dermatomyositis in the acute phase. The patient received therapy with steroids and tacrolimus, also making several rounds of treatment with immunoglobulin. Given the recurrence of myositis in association with signs of poorly controlled interstitial lung disease, immunosuppressive therapy with Rituximab was administered. The Computed Tomography (CT) scans showed "bronchiectasis and traction bronchiolectasis, hypodense areas consistent with the phenomena of air trapping. The pattern of interstitial lung disease with fibrotic evolution seems consistent with NSIP. The arterial blood gas analysis showed a pattern of hypoxic-hypercapnic respiratory failure (pH: 7,34, PaO2: 67 mmHg; PaCO2: 55 mmHg). As a result of an episode of marked desaturation unresponsive to supplemental oxygen at high flows we proceeded to noninvasive mechanical ventilation with Helmet for 24 hours/24. This ventilatory support was maintained for a week, with resolution of the respiratory failure. In this brief case report we want to highlight various pulmonary complications as a result of dermatomyositis. The progression of respiratory complications may also lead to a situation of respiratory failure, as in our patient, and require a noninvasive ventilatory treatment.
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Affiliation(s)
- Ivano Salimbene
- Department of Pulmonary Medicine, A, Gemelli University Polyclinic, Sacro Cuore Catholic University, Largo A, Gemelli 8, Rome, 00168, Italy.
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