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Millan-Billi P, Castellví I, Martinez-Martinez L, Mariscal A, Barril S, D'Alessandro M, Franquet T, Castillo D. Diagnostic Value of Krebs von den Lungen (KL-6) for Interstitial Lung Disease: A European Prospective Cohort. Arch Bronconeumol 2024:S0300-2896(24)00088-7. [PMID: 38644152 DOI: 10.1016/j.arbres.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/15/2024] [Accepted: 03/31/2024] [Indexed: 04/23/2024]
Abstract
INTRODUCTION Krebs von den Lungen 6 (KL-6) is a mucin-1 glycoprotein produced by type II pneumocytes. High levels of KL-6 in blood may be found in patients with lung fibrosis. In Asia this biomarker is used for diagnosis and prognosis in interstitial lung diseases (ILD). There is a lack of information regarding KL-6 cut-off point for diagnosis and prognosis in European population. The aim of this study was to establish the cut-off point for serum KL-6 associated with the presence of ILD in the Spanish population. METHODS Prospective study including subjects who underwent chest HRCT, PFTs and autoimmune blood analysis. Two groups were created: non-ILD subjects and ILD patients. Serum KL-6 concentrations were measured using a Lumipulse KL-6 reagent assay and the optimal cut-off value was evaluated by a ROC analysis. Data on demographics and smoking history was also collected. RESULTS One hundred seventy-nine patients were included, 102 with ILD. Median serum KL-6 values overall were 762U/mL, 1080 (±787)U/mL for the ILD group vs 340 (±152)U/mL for the non-ILD group (p<0.0001). The main radiological pattern was NSIP (43%). ROC analysis showed greater specificity (86%) and sensitivity (82%) for KL-6 465U/mL for detecting ILD patients. The multivariate logistic regression model pointed to the male sex, higher KL-6 values, lower FVC and low DLCO values as independent factors associated with ILD. CONCLUSION Serum KL-6 values greater than 465U/mL have excellent sensitivity and specificity for detecting ILD in our Spanish cohort. Multicentre studies are needed to validate our results.
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Affiliation(s)
- Paloma Millan-Billi
- Respiratory Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Respiratory Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Spain
| | - Iván Castellví
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Spain; Rheumatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Martinez-Martinez
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Immunology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Cellular Biology, Physiology, and Immunology Department, Universitat Autònoma de Barcelona, Spain
| | - Anais Mariscal
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Immunology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Cellular Biology, Physiology, and Immunology Department, Universitat Autònoma de Barcelona, Spain
| | - Silvia Barril
- Respiratory Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Cellular Biology, Physiology, and Immunology Department, Universitat Autònoma de Barcelona, Spain; Respiratory Medicine Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - Miriana D'Alessandro
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, Siena, Italy
| | - Tomás Franquet
- Radiology Department, Thoracic Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Diego Castillo
- Respiratory Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Spain.
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Atienza-Mateo B, Fernández-Díaz C, Vicente-Rabaneda EF, Melero-González RB, Ortiz-Sanjuán F, Casafont-Solé I, Rodríguez-García SC, Ferraz-Amaro I, Castañeda S, Blanco R. Abatacept in usual and in non-specific interstitial pneumonia associated with rheumatoid arthritis. Eur J Intern Med 2024; 119:118-124. [PMID: 37673775 DOI: 10.1016/j.ejim.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/21/2023] [Accepted: 08/26/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To compare the effectiveness of abatacept (ABA) in Rheumatoid Arthritis-associated Interstitial Lung Disease (RA-ILD) according to the radiological patterns of usual (UIP) or non-specific interstitial pneumonia (NSIP). METHODS From an observational longitudinal multicentre study of 263 RA-ILD patients treated with ABA, those with UIP or NSIP were selected. Lung function, chest high resolution computerised tomography (HRCT) and dyspnoea were recorded and compared in both groups from baseline to the end of follow-up (progression definitions: improvement or worsening >10% of FVC or DLCO, changes in HRCT extension and 1-point change in the mMRC scale, respectively). Differences between final and baseline visits were calculated as the average difference (95% CI) through mixed effects models regression. RESULTS We studied 190 patients with UIP (n=106) and NSIP (n=84). General features were similar in both groups except for older age, positive rheumatoid factor, and previous sulfasalazine therapy, which were more frequent in patients with UIP. ILD duration up to ABA initiation was relatively short: median 16 [4-50] and 11 [2-36] months (p=0.36) in UIP and NSIP, respectively. Mean baseline FVC and DLCO were 82% and 63% in UIP and 89% and 65% in NSIP, respectively. Both parameters remained stable during 24 months with ABA. HRCT lesions and dyspnoea improved/stabilized in 73.1% and 90.5% and 72.9% and 94.6% of UIP and NSIP patterns, respectively. CONCLUSION ABA seems equally effective in stabilizing dyspnoea, lung function and radiological impairment in both UIP and NSIP patterns of RA-ILD. Early administration of ABA may prevent RA-ILD progression, regardless of the radiological pattern.
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Affiliation(s)
- Belén Atienza-Mateo
- Rheumatology, Hospital Universitario Marqués de Valdecilla, Immunopathology group, IDIVAL, Santander, Avda.Valdecilla s/n., ES, 39008, Spain
| | | | | | | | | | | | | | - Iván Ferraz-Amaro
- Rheumatology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Santos Castañeda
- Rheumatology, Hospital de La Princesa, IIS-Princesa, Madrid, Spain; Cátedra UAM-Roche, EPID-Future, Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ricardo Blanco
- Rheumatology, Hospital Universitario Marqués de Valdecilla, Immunopathology group, IDIVAL, Santander, Avda.Valdecilla s/n., ES, 39008, Spain.
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Conticini E, d'Alessandro M, Cameli P, Bergantini L, Pordon E, Cassai L, Cantarini L, Bargagli E, Frediani B, Porcelli B. Prevalence of myositis specific and associated antibodies in a cohort of patients affected by idiopathic NSIP and no hint of inflammatory myopathies. Immunol Res 2023; 71:735-742. [PMID: 37133680 PMCID: PMC10517890 DOI: 10.1007/s12026-023-09387-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/24/2023] [Indexed: 05/04/2023]
Abstract
The presence of interstitial lung disease (ILD) is a common and fearsome feature of idiopathic inflammatory myopathies (IIM). Such patients show radiological pattern of non-specific interstitial pneumonia (NSIP). The present study aimed to assess the prevalence of myositis-specific and myositis-associated antibodies (MSA and MAA) in a cohort of patients with a previous diagnosis of NSIP and no sign or symptom of IIM. Secondly, it will be assessed whether patients displaying MSA and/or MAA positivity have a worse or a better outcome than idiopathic NSIP. All patients affected by idiopathic NSIP were enrolled. MSA and MAA were detected using EUROLINE Autoimmune Inflammatory Myopathies 20 Ag (Euroimmun Lubeck, Germany), line immunoassay. A total of 16 patients (mean age 72 ± 6.1 years old) were enrolled. Six out of 16 patients (37.5%) had significant MSA and/or MAA positivity: one displayed positivity of anti-PL-7 (+ +), one of anti-Zo (+ +), anti-TIF1γ (+ + +) and anti-Pm-Scl 75 (+ + +), one of anti-Ro52 (+ +), one of anti-Mi2β (+ + +), one of anti-Pm-Scl 75 (+ + +) and the latter of both anti-EJ (+ + +) and anti-Ro52 (+ + +).Two out of 7 seropositive patients showed a significant impairment of FVC (relative risk 4.8, 95% CI 0.78-29.5; p = 0.0350). Accordingly, among the 5 patients that started antifibrotic treatment during the observation time, 4 were seronegative. Our findings highlighted a potential autoimmune or inflammatory in idiopathic NSIP patients and also in those without significant rheumatological symptoms. A more accurate diagnostic assessment may ameliorate diagnostic accuracy as well as may provide new therapeutic strategy (antifibrotic + immunosuppressive). A cautious assessment of NSIP patients with a progressive and non-responsive to glucocorticoids disease course should therefore include an autoimmunity panel comprising MSA and MAA.
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Affiliation(s)
- Edoardo Conticini
- Department of Medicine, Surgery & Neurosciences, Rheumatology Unit, University of Siena, 53100, Siena, Italy
| | - Miriana d'Alessandro
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, University of Siena, Viale Bracci 1, 53100, Siena, Italy.
| | - Paolo Cameli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - Laura Bergantini
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - Elena Pordon
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - Lucia Cassai
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - Luca Cantarini
- Department of Medicine, Surgery & Neurosciences, Rheumatology Unit, University of Siena, 53100, Siena, Italy
| | - Elena Bargagli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, University of Siena, Viale Bracci 1, 53100, Siena, Italy
| | - Bruno Frediani
- Department of Medicine, Surgery & Neurosciences, Rheumatology Unit, University of Siena, 53100, Siena, Italy
| | - Brunetta Porcelli
- UOC Laboratorio Patologia Clinica, Policlinico S. Maria Alle Scotte, AOU Senese, Siena, Italy
- Dipartimento Biotecnologie Mediche, Università Degli Studi Di Siena, Siena, Italy
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Carbone RG, Monselise A, Barisione E, Fontana V, Paredi P, Puppo F. Pulmonary hypertension in systemic sclerosis with usual interstitial pneumonia. Intern Emerg Med 2023:10.1007/s11739-023-03267-y. [PMID: 37069417 DOI: 10.1007/s11739-023-03267-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/31/2023] [Indexed: 04/19/2023]
Abstract
Retrospective study comparing pulmonary hypertension risk in systemic sclerosis (SSc) and non-SSc interstitial lung disease patients with usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP). Retrospective analysis of 144 interstitial lung disease patients, 53 SSc (32 UIP and 21 NSIP) and 91 non-SSc (47 UIP and 44 NSIP). Pulmonary hypertension was diagnosed as pulmonary systolic artery pressure (PAPs) > 25 mmHg. All SSc and non-SSc patients with pulmonary hypertension were classified WHO Group 3. Pulmonary hypertension was identified in 21/32 (65.6%), 9/21 (42.8%), 14/47 (29.7%), and 28/44 (45.4%) SSc-UIP, SSc-NSIP, control-UIP, and control-NSIP groups, respectively. PAPs mean of SSc-UIP group was higher than control-UIP group (32.6 ± 9.8 vs 28.5 ± 6.6, p-value = 0.02). PAPs mean of SSc-NSIP group was lower than control-NSIP group (27.0 ± 7.1 vs 33.9 ± 8.8, p = 0.002). Frequency of patients with PAP > 25 mmHg in SSc-UIP group was 60% higher in comparison to control-UIP (OR = 1.62, 95% CI 0.51-5.16) and SSc-NSIP (OR = 1.60, 95% CI 0.45-5.70) groups. Logistic regression analysis estimating the linear trend per ten-unit increase in PAPs levels demonstrated an increment for the SSc-UIP group compared to the control-UIP (OR = 2.64, 95% CI 1.25-5.58, p = 0.01) and the control-NSIP (OR = 6.34, 95% CI 2.82-14.3, p < 0.001) groups. The case-control study confirms that pulmonary hypertension is frequently found in SSc patients and demonstrates, for the first time, a significant increased risk of pulmonary hypertension among SSc-UIP patients.
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Affiliation(s)
| | | | | | - Vincenzo Fontana
- Clinical Epidemiology Unit, IRCCS San Martino Hospital, Genoa, Italy
| | | | - Francesco Puppo
- Department of Internal Medicine, University of Genoa, Genoa, Italy.
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Dahal K, Chaudhary A, Rawal L, Ray U, Paudel S, Khanal P, Gyawali P, Sah SK, Shrestha KK, Pandey S. Antisynthetase syndrome and interstitial lung disease: A case report. Ann Med Surg (Lond) 2022; 82:104571. [PMID: 36268301 PMCID: PMC9577423 DOI: 10.1016/j.amsu.2022.104571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Myositis, Raynaud's phenomenon, fever, interstitial lung disease, mechanic's hands, and arthropathy are symptoms of Antisynthetase Syndrome (ASS), which is defined by the development of antibodies against t-ribonucleic acid (RNA) synthetase, particularly anti-Jo-1. Case presentation The case is about 29 years female with 1 month history of non-productive cough and dyspnea on exertion which was later diagnosed as ASS. Discussion The diagnosis of an inflammatory myopathy is based on clinical findings such as subacute development of symmetrical muscle weakness and signs such as laboratory investigations revealing skeletal muscle inflammation. Creatinine phosphokinase (CPK) is mainly used to demonstrate skeletal muscle involvement. Conclusion Interstitial lung disease is a frequent occurrence and is associated with a bad prognosis during the course of antisynthetase syndrome.
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Affiliation(s)
- Krishna Dahal
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | - Anand Chaudhary
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | - Laba Rawal
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | - Umesh Ray
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | - Sandip Paudel
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | - Pitambar Khanal
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | - Pawan Gyawali
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | - Sanjit Kumar Sah
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
| | | | - Shailendra Pandey
- Tribhuvan University, Institute of Medicine, Maharajgunj, 44600, Nepal
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王 飞, 朱 翔, 贺 蓓, 朱 红, 沈 宁. [Spontaneous remission of follicular bronchiolitis with nonspecific interstitial pneumonia: A case report and literature review]. Beijing Da Xue Xue Bao Yi Xue Ban 2021; 53:1196-1200. [PMID: 34916705 PMCID: PMC8695155 DOI: 10.19723/j.issn.1671-167x.2021.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Indexed: 06/14/2023]
Abstract
A 41-year-old female patient was admitted in Department of Respiratory and Critical Care Medicine, Peking University Third Hospital because of having cough for a year. Multiple subpleural ground grass and solid nodules could be seen on her CT scan. Four months before admission, she began to experience dry mouth and eyes, blurred vision, finger joints pain, muscle pain and weakness in both lower limbs and weight loss. At the time of admission, the patient's vital signs were normal, no skin rash was seen, breath sounds in both lungs were clear, no rales or wheeze, no deformities in her hands, no redness, swelling, or tenderness in the joints. There was no edema in both lower limbs. Some lab examinations were performed. Tumor markers including squamous cell carcinoma (SCC) antigen, neuron-specific enolase (NSE), carcinoembryonic antigen (CEA), Cyfra21-1, pro-gastrin-releasing peptide (proGRP), carbohydrate antigen 125 (CA125) and carbohydrate antigen 199 (CA199) were all normal. The antinuclear antibody, rheumatoid factor, antineutrophil cytoplasmic antibody, anti-dsDNA antibody, anti-Sm antibody, anti-SSA/SSB antibody, anti-ribonucleoprotein (RNP) antibody, anti-Jo-1 antibody, anti-SCL-70 antibody and anti-ribosomal antibody were all negative. The blood IgG level was normal. The blood fungal β-1.3-D glucose, aspergillus galactomannan antigen, sputum bacterial and fungal culture, and sputum smear test for acid-fast staining were all negative. Lung function was normal. Bronchoscopy showed the airways and mucosa were normal. To clarify the diagnosis, she underwent thoracoscopic lung biopsy, the histopathology revealed follicular bronchiolitis (FB) with nonspecific interstitial pneumonia (NSIP). She did not receive any treatment and after 7 months, the lung opacities were spontaneously resolved. After 7 years of follow-up, the opacities in her lung did not relapse. To improve the understanding of FB, a literature research was performed with "follicular bronchiolitis" as the key word in Wanfang, PubMed and Ovid Database. The time interval was from January 2000 to December 2018. Relative articles were retrieved and clinical treatments and prognosis of FB were analyzed. Eighteen articles concerning FB with complete records were included in the literature review. A total of 51 adult patients with FB were reported, including 18 primary FB and 33 secondary FB, and autoimmune disease was the most common underlying cause. Forty-one (80.4%) patients were prescribed with corticosteroids and/or immunosuppressive agents, 6 (11.8%) patients were treated with anti-infective, 5 (9.8%) patients did not receive any treatment. The longest follow-up period was 107 months. Among the 5 patients without any treatment, 1 patients died of metastatic melanoma, the lung opacities were unchanged in 1 patient and getting severe in 3 patients. In conclusion, FB is a rare disease, the treatment and prognosis are controversial. Corticosteroid and immunosuppressive agents could be effective. This case report suggests the possibility of spontaneous remission of FB.
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Affiliation(s)
- 飞 王
- 北京大学第三医院呼吸与危重医学科,北京 100191Department of Respiratory and Critical Care Medicine, Beijing 100191, China
| | - 翔 朱
- 北京大学第三医院病理科,北京 100191Department of Pathology, Peking University Third Hospital, Beijing 100191, China
| | - 蓓 贺
- 北京大学第三医院呼吸与危重医学科,北京 100191Department of Respiratory and Critical Care Medicine, Beijing 100191, China
| | - 红 朱
- 北京大学第三医院呼吸与危重医学科,北京 100191Department of Respiratory and Critical Care Medicine, Beijing 100191, China
| | - 宁 沈
- 北京大学第三医院呼吸与危重医学科,北京 100191Department of Respiratory and Critical Care Medicine, Beijing 100191, China
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王 飞, 朱 翔, 贺 蓓, 朱 红, 沈 宁. [Spontaneous remission of follicular bronchiolitis with nonspecific interstitial pneumonia: A case report and literature review]. Beijing Da Xue Xue Bao Yi Xue Ban 2021; 53:1196-1200. [PMID: 34916705 PMCID: PMC8695155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Indexed: 09/22/2023]
Abstract
A 41-year-old female patient was admitted in Department of Respiratory and Critical Care Medicine, Peking University Third Hospital because of having cough for a year. Multiple subpleural ground grass and solid nodules could be seen on her CT scan. Four months before admission, she began to experience dry mouth and eyes, blurred vision, finger joints pain, muscle pain and weakness in both lower limbs and weight loss. At the time of admission, the patient's vital signs were normal, no skin rash was seen, breath sounds in both lungs were clear, no rales or wheeze, no deformities in her hands, no redness, swelling, or tenderness in the joints. There was no edema in both lower limbs. Some lab examinations were performed. Tumor markers including squamous cell carcinoma (SCC) antigen, neuron-specific enolase (NSE), carcinoembryonic antigen (CEA), Cyfra21-1, pro-gastrin-releasing peptide (proGRP), carbohydrate antigen 125 (CA125) and carbohydrate antigen 199 (CA199) were all normal. The antinuclear antibody, rheumatoid factor, antineutrophil cytoplasmic antibody, anti-dsDNA antibody, anti-Sm antibody, anti-SSA/SSB antibody, anti-ribonucleoprotein (RNP) antibody, anti-Jo-1 antibody, anti-SCL-70 antibody and anti-ribosomal antibody were all negative. The blood IgG level was normal. The blood fungal β-1.3-D glucose, aspergillus galactomannan antigen, sputum bacterial and fungal culture, and sputum smear test for acid-fast staining were all negative. Lung function was normal. Bronchoscopy showed the airways and mucosa were normal. To clarify the diagnosis, she underwent thoracoscopic lung biopsy, the histopathology revealed follicular bronchiolitis (FB) with nonspecific interstitial pneumonia (NSIP). She did not receive any treatment and after 7 months, the lung opacities were spontaneously resolved. After 7 years of follow-up, the opacities in her lung did not relapse. To improve the understanding of FB, a literature research was performed with "follicular bronchiolitis" as the key word in Wanfang, PubMed and Ovid Database. The time interval was from January 2000 to December 2018. Relative articles were retrieved and clinical treatments and prognosis of FB were analyzed. Eighteen articles concerning FB with complete records were included in the literature review. A total of 51 adult patients with FB were reported, including 18 primary FB and 33 secondary FB, and autoimmune disease was the most common underlying cause. Forty-one (80.4%) patients were prescribed with corticosteroids and/or immunosuppressive agents, 6 (11.8%) patients were treated with anti-infective, 5 (9.8%) patients did not receive any treatment. The longest follow-up period was 107 months. Among the 5 patients without any treatment, 1 patients died of metastatic melanoma, the lung opacities were unchanged in 1 patient and getting severe in 3 patients. In conclusion, FB is a rare disease, the treatment and prognosis are controversial. Corticosteroid and immunosuppressive agents could be effective. This case report suggests the possibility of spontaneous remission of FB.
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Affiliation(s)
- 飞 王
- 北京大学第三医院呼吸与危重医学科,北京 100191Department of Respiratory and Critical Care Medicine, Beijing 100191, China
| | - 翔 朱
- 北京大学第三医院病理科,北京 100191Department of Pathology, Peking University Third Hospital, Beijing 100191, China
| | - 蓓 贺
- 北京大学第三医院呼吸与危重医学科,北京 100191Department of Respiratory and Critical Care Medicine, Beijing 100191, China
| | - 红 朱
- 北京大学第三医院呼吸与危重医学科,北京 100191Department of Respiratory and Critical Care Medicine, Beijing 100191, China
| | - 宁 沈
- 北京大学第三医院呼吸与危重医学科,北京 100191Department of Respiratory and Critical Care Medicine, Beijing 100191, China
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Møller J, Altraja A, Sjåheim T, Rasmussen F, Madsen LB, Bendstrup E. International multidisciplinary team discussions on the diagnosis of idiopathic non-specific interstitial pneumonia and the development of connective tissue disease. Eur Clin Respir J 2021; 8:1933878. [PMID: 34178296 PMCID: PMC8205078 DOI: 10.1080/20018525.2021.1933878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/13/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Idiopathic Non-Specific Interstitial Pneumonia (iNSIP) is a rare interstitial lung disease, diagnosed, by definition, on the basis of a multidisciplinary team discussion (MDD). Association with an autoimmune background has been suggested in iNSIP. AIMS To test the feasibility of conducting a multinational MDD to review the diagnosis in iNSIP cases and to estimate the emergence of connective tissue disease (CTD) during follow-up. METHODS Investigators from three expert centers (Denmark, Estonia and Norway) met and discussed cases of biopsy-proven iNSIP at an international MDD. The cases were previously diagnosed at a national level between 2004 and 2014. Based on clinical, radiographic and pathological data, the diagnosis of iNSIP was re-evaluated and a consensus diagnosis was made. Cases incompatible with iNSIP were excluded. Relevant data were registered comprising any development of CTD. RESULTS In total, 31 cases were discussed and 23 patients were included with a diagnosis of iNSIP. The mean follow-up time was 57 months. None of the patients developed CTD according to the rheumatologic criteria during the follow up period. Four patients (17.4%) met the criteria for interstitial pneumonia with autoimmune features. CONCLUSION We found that an international MDD was a feasible and valuable tool in the retrospective diagnostic evaluation of iNSIP. Diagnosis was changed in a statistically significant number of patients by our international MDD team. None of the patients developed CTD during follow-up.
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Affiliation(s)
- Janne Møller
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Alan Altraja
- Department of Pulmonary Medicine, University of Tartu, Tartu, Estonia
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Tone Sjåheim
- Department of Respiratory Diseases, Oslo University Hospital, Oslo, Norway
| | - Finn Rasmussen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Line Bille Madsen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
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O'Mahony AM, Burke L, Cavazza A, Maher MM, Kennedy MP, Henry MT. Transbronchial lung cryobiopsy (TBLC) in the diagnosis of interstitial lung disease: experience of first 100 cases performed under conscious sedation with flexible bronchoscope. Ir J Med Sci 2021; 190:1509-1517. [PMID: 33471301 DOI: 10.1007/s11845-020-02453-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Diagnosing the aetiology of interstitial lung disease (ILD) may require histology via a surgical lung biopsy (SLB). SLB is associated with significant complications. Transbronchial lung cryobiopsy (TBLC) can provide large, adequate biopsies with fewer complications offering a potential alternative to SLB. AIMS This study evaluated the safety, diagnostic yield and impact of TBLC on diagnostic certainty in the multidisciplinary diagnosis (MDD) of ILD within routine clinical practice. METHODS A retrospective study of all TBLC performed in a tertiary institute from March 2014 to December 2016 was performed. Procedures were performed using a flexible bronchoscope and cryoprobe without fluoroscopic guidance. RESULTS One hundred procedures were performed on 85 patients. A total of 272 cryobiopsies were obtained with a mean biopsy diameter of 5.9 ± 3.2 mm. Ninety-seven percent contained alveolated lung tissue. Diagnosis based against MDD gold standard was confirmed using TBLC in 67.1% of patients and in 72/100 procedures. Three patients proceeded to SLB. The addition of histological information changed the clinic-radiological diagnosis in twelve patients. The most common diagnosis based on clinical-radiologic-pathologic correlation at MDD was idiopathic pulmonary fibrosis (IPF) (51.2%) and hypersensitivity pneumonitis (15.9%). Moderate bleeding occurred in 18% of cases and five patients (5%) developed pneumothorax requiring intervention. Eleven patients required admission, with a mean length of stay of 1.3 ± 0.9 days. CONCLUSION TBLC aids the diagnosis of ILD in the appropriate patient and may be an acceptable alternative to SLB with fewer complications. Further work on standardizing the procedure is required.
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Affiliation(s)
- Anne M O'Mahony
- Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Ireland.
| | - Louise Burke
- Department of Histopathology, Cork University Hospital, Cork, Ireland
| | - Alberto Cavazza
- Department of Pathology, Arcispedale S Maria Nuova, Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Marcus P Kennedy
- Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Ireland
| | - Michael T Henry
- Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Ireland
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10
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Nabeya D, Yoshimatsu Y, Fujiwara H. A case of acute progressive diffuse interstitial lung disease preceding idiopathic multicentric Castleman disease. Respir Med Case Rep 2020; 31:101216. [PMID: 32995258 PMCID: PMC7502372 DOI: 10.1016/j.rmcr.2020.101216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/08/2020] [Accepted: 09/07/2020] [Indexed: 12/01/2022] Open
Abstract
It has been considered that idiopathic multicentric Castleman disease often involves pulmonary complications recognized as lymphocytic interstitial pneumonia. On the other hand, recent reports show that the computed tomography often show diffuse interstitial lung disease inconsistence with lymphocytic interstitial pneumonia. Pulmonary diseases with idiopathic multicentric Castleman disease are still rare and poorly understood. Here, we report a case of acute progressive diffuse interstitial lung disease, diagnosed as non-specific interstitial pneumonia, preceding idiopathic multicentric Castleman disease. A 65-year-old male visited our outpatient clinic for dyspnea on exertion. Imaging tests revealed interstitial lung disease showing non-specific interstitial pneumonia pattern, pulmonary function test proved the decline of vital capacity and laboratory tests showed increased fibrosis biomarkers; therefore, initially, he had been diagnosed as non-specific interstitial pneumonia. However, imaging tests also showed mediastinum lymphadenopathy, and laboratory tests revealed increased interleukin-6. Idiopathic multicentric Castleman disease was suspected. The lung and mediastinum lymph node biopsies were performed, and pathological findings of the lymph nodes were compatible with multicentric Castleman disease. Pathological findings of the lung showed that the fibrous thickening of interstitium and the collapse of alveoli. We diagnosed this case as idiopathic multicentric Castleman disease preceded by diffuse interstitial lung disease. Treatment with prednisolone improved the dyspnea, and the pulmonary lesions disappeared. The presented case suggests that interstitial lung disease could precede idiopathic multicentric Castleman disease. Chest physicians should be aware that idiopathic multicentric Castleman disease is one of the causative diseases of diffuse interstitial lung disease like non-specific interstitial pneumonia on the chest images.
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Affiliation(s)
- Daijiro Nabeya
- Department of Respiratory Medicine, Okinawa Chubu Hospital, Okinawa, Japan.,Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yuki Yoshimatsu
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Hiroshi Fujiwara
- Department of Respiratory Medicine, Yodogawa Christian Hospital, Osaka, Japan
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11
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Zhan X, Liu B, Tong ZH. [Postinflammatroy pulmonary fibrosis of COVID-19: the current status and perspective]. Zhonghua Jie He He Hu Xi Za Zhi 2020; 43:728-732. [PMID: 32894907 DOI: 10.3760/cma.j.cn112147-20200317-00359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The novel coronavirus pneumonia (COVID-19) has been well controlled in China. Most of the COVID-19 patients were having postinflammatory pulmonary fibrosis (PPF) on the follow-up CT scan when discharged, and complaining about exertional dyspnea of different levels, presenting with an UIP (usual interstitial pneumonia) pattern or NSIP (non-specific interstitial pneumonia) pattern on the CT scans. Will the PPF get improved or stay stable, or progress? Such questions could only be answered by follow-up and monitoring of the pulmonary function. At the same time, we should learn from the lessons on pulmonary function loss of the SARS patients and MERS patients, some of whom had persistent impaired lung function after discharge. Pirfenidone and Nintedanib had been approved for the treatment of idiopathic pulmonary fibrosis(IPF), showing effectiveness on non-IPF pulmonary fibrosis as well. However, there are no studies about the application on PPF resulting from viral pneumonia. Given the follow-up status of SARS patients and MERS patients, and the PPF of COVID-19 patients, we should be careful about the discharged patients with a close follow-up, and further studies on PPF of COVID-19 are needed.
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Affiliation(s)
- X Zhan
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - B Liu
- Department of Respiratory and Critical Care Medicine, Zhongnan Hospital, Wuhan University, Wuhan 430071, China
| | - Z H Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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12
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Maillet T, Goletto T, Beltramo G, Dupuy H, Jouneau S, Borie R, Crestani B, Cottin V, Blockmans D, Lazaro E, Naccache JM, Pugnet G, Nunes H, de Menthon M, Devilliers H, Bonniaud P, Puéchal X, Mouthon L, Bonnotte B, Guillevin L, Terrier B, Samson M. Usual interstitial pneumonia in ANCA-associated vasculitis: A poor prognostic factor. J Autoimmun 2019; 106:102338. [PMID: 31570253 DOI: 10.1016/j.jaut.2019.102338] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Progressive fibrosing interstitial lung disease (ILD) is rarely associated with antineutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV). This study focused on the outcomes of ILD patients with associated AAV (AAV-ILD). METHODS AAV-ILD (cases: microscopic polyangiitis (MPA) or granulomatosis with polyangiitis (GPA) with ILD) were compared to AAV patients without ILD (controls). ILD was defined as a usual interstitial pneumonia (UIP) or non-specific interstitial pneumonia (NSIP) pattern. Two controls were matched to each case for age (>or ≤65 years), ANCA status (PR3-or MPO-positive) and creatininemia (≥or <150 μmol/L). RESULTS Sixty-two cases (89% MPO-ANCA+) were included. Median age at AAV diagnosis was 66 years. ILD (63% UIP), was diagnosed before (52%) or simultaneously (39%) with AAV. Cases versus 124 controls less frequently had systemic vasculitis symptoms. One-, 3- and 5-year overall survival rates, respectively, were: 96.7%, 80% and 66% for cases versus 93.5%, 89.6% and 83.8% for controls (p = 0.008). Multivariate analyses retained age >65 years (hazard ratio (HR) 4.54; p < 0.001), alveolar haemorrhage (HR 2.25; p = 0.019) and UIP (HR 2.73; p = 0.002), but not immunosuppressant use, as factors independently associated with shorter survival. CONCLUSION For AAV-ILD patients, only UIP was associated with poorer prognosis. Immunosuppressants did not improve the AAV-ILD prognosis. But in analogy to idiopathic pulmonary fibrosis, anti-fibrosing agents might be useful and should be assessed in AAV-ILD patients with a UIP pattern.
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Affiliation(s)
- Thibault Maillet
- Department of Internal Medicine and Clinical Immunology, CHU Dijon Bourgogne, Dijon, France
| | - Tiphaine Goletto
- Department of Pulmonology, Hôpital Saint-Louis, APHP, Paris, France
| | - Guillaume Beltramo
- Respiratory and ICU Department, Referral Center for Adults Rare Pulmonary Diseases, Inserm 1231, CHU Dijon-Bourgogne, Dijon, France
| | - Henry Dupuy
- Department of Internal Medicine and Infectious Diseases, Hôpital Haut-Lévêque, Bordeaux, France
| | - Stéphane Jouneau
- Department of Pulmonology, Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR S, 1085, Rennes, France
| | - Raphael Borie
- Department of Pulmonology, Hôpital Bichat, APHP, Paris, France
| | - Bruno Crestani
- Department of Pulmonology, Hôpital Bichat, APHP, Paris, France
| | - Vincent Cottin
- Department of Pulmonology, Hôpital Louis-Pradel, Bron, France
| | - Daniel Blockmans
- Department of Internal Medicine, UZ Leuven Hospital, Leuven, Belgium
| | - Estibaliz Lazaro
- Department of Internal Medicine and Infectious Diseases, Hôpital Haut-Lévêque, Bordeaux, France
| | - Jean-Marc Naccache
- Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Tenon, Service de Pneumologie, Site Constitutif Du Centre de Référence des Maladies Pulmonaires Rares OrphaLung, Paris, France
| | - Grégory Pugnet
- Department of Internal Medicine, CHU de Toulouse, Toulouse, France
| | - Hilario Nunes
- Department of Pulmonology, Hôpital Avicenne, APHP, Bobigny, France
| | - Mathilde de Menthon
- Department of Internal Medicine, Hôpital Bicêtre, APHP, Le Kremlin-Bicêtre, France
| | - Hervé Devilliers
- Department of Internal Medicine and Systemic Diseases, CHU Dijon-Bourgogne, Dijon, France
| | - Philippe Bonniaud
- Respiratory and ICU Department, Referral Center for Adults Rare Pulmonary Diseases, Inserm 1231, CHU Dijon-Bourgogne, Dijon, France
| | - Xavier Puéchal
- Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, APHP, Inserm U1016, Université Paris Descartes, Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, APHP, Inserm U1016, Université Paris Descartes, Paris, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, CHU Dijon Bourgogne, Dijon, France
| | - Loïc Guillevin
- Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, APHP, Inserm U1016, Université Paris Descartes, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, APHP, Inserm U1016, Université Paris Descartes, Paris, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, CHU Dijon Bourgogne, Dijon, France
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13
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McFarlane IM, Zhaz SY, Bhamra MS, Burza A, Kolla S, Alvarez MR, Koci K, Taklalsingh N, Pathiparampil J, Freeman L, Kaplan I, Kabani N, Ozeri DJ, Watler E, Frefer M, Vaitkus V, Matthew K, Arroyo-Mercado F, Lyo H, Zrodlowski T, Feoktistov A, Sanchez R, Sorrento C, Soliman F, Valdez FR, Dronamraju V, Trevisonno M, Grant C, Clerger G, Amin K, Dawkins M, Green J, Moon J, Fahmy S, Waite SA. Assessment of interstitial lung disease among black rheumatoid arthritis patients. Clin Rheumatol 2019; 38:3413-3424. [PMID: 31471819 DOI: 10.1007/s10067-019-04760-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/01/2019] [Accepted: 08/20/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Conflicting reports exist regarding the racial and the gender distribution of rheumatoid arthritis-related interstitial lung disease (RA-ILD). In a major population study of predominately Whites, RA-ILD was reported mainly among smoker middle-aged men. However, recent data suggest that the disease is that of elderly women. Our study aimed to assess the prevalence and identify the gender differences and clinical characteristics of RA-ILD in a predominantly Black population. METHODS Cross-sectional analysis of data obtained from the records of 1142 patients with RA diagnosis by ICD codes of which 503 cases met the inclusion criteria for the study. Eighty-six patients had chronic respiratory symptoms of cough and dyspnea and were further assessed by our multidisciplinary group of investigators. Thirty-two subjects with an established diagnosis of rheumatoid arthritis met the diagnostic criteria for interstitial lung disease. RESULTS Of the 32 patients with RA-ILD, mean age was 62.6 ± 2.2 (± SEM), 93.7% were females, and 89% Blacks with a BMI = 29.2 (Kg/m2). Usual interstitial pneumonia (UIP) was found in 24/32 (75%) of the cases. Seventy-two percent of the RA-ILD patient had seropositive RA. Smoking history was reported in 31.3% of the cohort, gastroesophageal reflux disease (GERD) in 32.3%, and cardiovascular disease (CVD) risk factors in 65.6%. CONCLUSION Our study indicates RA-ILD among Blacks is predominantly a disease of elderly females with higher rates of GERD and CVD risk factors. Further studies are needed to identify the pathogenetic differences accounting for the gender distribution of RA-ILD among Black and White populations.Key Points• First study to assess ILD among predominantly Black RA patients.• The prevalence of RA-associated ILD was 6.36%, affecting mostly women in their sixth decade with seropositive disease.• COPD was the most common airway disease among non-RA-ILD Black population.• GERD was found in approximately one-third of patients with RA-associated ILD versus one-fifth of those RA patients without any lung disease.
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Affiliation(s)
- Isabel M McFarlane
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA. .,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA.
| | - Su Yien Zhaz
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Samaritan Medical Center Department of Rheumatology, Watertown, NY, 13601, USA
| | - Manjeet S Bhamra
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Aaliya Burza
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Medicine, Division of Pulmonary and Critical Care State, SUNY Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Srinivas Kolla
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Radiology, SUNY Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Milena Rodriguez Alvarez
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Kristaq Koci
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Nicholas Taklalsingh
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Joshy Pathiparampil
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Latoya Freeman
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Ian Kaplan
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Naureen Kabani
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - David J Ozeri
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Sheba Medical Center, 6100000, Tel Aviv, Israel
| | - Elsie Watler
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Mosab Frefer
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Vytas Vaitkus
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Keron Matthew
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Fray Arroyo-Mercado
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Helen Lyo
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Tomasz Zrodlowski
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Aleksander Feoktistov
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Randolph Sanchez
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Rheumatology, Hahnemann Hospital, Philadelphia, PA, 19019, USA
| | - Cristina Sorrento
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Faisal Soliman
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Geriatrics, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, 11201, USA
| | - Felix Reyes Valdez
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Family and Social Medicine, Montefiore Medical Center Albert Einstein College of Medicine, Bronx, NY, 10468, USA
| | - Veena Dronamraju
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Michael Trevisonno
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Christon Grant
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Guerrier Clerger
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Khabbab Amin
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Makeda Dawkins
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Jason Green
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Jane Moon
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Internal Medicine, Division of Rheumatology, SUNY-Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Samir Fahmy
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Medicine, Division of Pulmonary and Critical Care State, SUNY Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
| | - Stephen Anthony Waite
- Department of Internal Medicine, Division of Rheumatology, Division of Pulmonary and Critical Care and Division of Radiology, State University of New York Downstate Medical Center and New York City Health & Hospitals Kings County, Brooklyn, NY, 11203, USA.,Department of Radiology, SUNY Downstate Medical Center, Health & Hospitals Kings County, Brooklyn, NY, 11201, USA
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14
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Jun S, Park B, Seo JB, Lee S, Kim N. Development of a Computer-Aided Differential Diagnosis System to Distinguish Between Usual Interstitial Pneumonia and Non-specific Interstitial Pneumonia Using Texture- and Shape-Based Hierarchical Classifiers on HRCT Images. J Digit Imaging 2019; 31:235-244. [PMID: 28884381 DOI: 10.1007/s10278-017-0018-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
A computer-aided differential diagnosis (CADD) system that distinguishes between usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP) using high-resolution computed tomography (HRCT) images was developed, and its results compared against the decision of a radiologist. Six local interstitial lung disease patterns in the images were determined, and 900 typical regions of interest were marked by an experienced radiologist. A support vector machine classifier was used to train and label the regions of interest of the lung parenchyma based on the texture and shape characteristics. Based on the regional classifications of the entire lung using HRCT, the distributions and extents of the six regional patterns were characterized through their CADD features. The disease division index of every area fraction combination and the asymmetric index between the left and right lungs were also evaluated. A second SVM classifier was employed to classify the UIP and NSIP, and features were selected through sequential-forward floating feature selection. For the evaluation, 54 HRCT images of UIP (n = 26) and NSIP (n = 28) patients clinically diagnosed by a pulmonologist were included and evaluated. The classification accuracy was measured based on a fivefold cross-validation with 20 repetitions using random shuffling. For comparison, thoracic radiologists assessed each case using HRCT images without clinical information or diagnosis. The accuracies of the radiologists' decisions were 75 and 87%. The accuracies of the CADD system using different features ranged from 70 to 81%. Finally, the accuracy of the proposed CADD system after sequential-forward feature selection was 91%.
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Affiliation(s)
- SangHoon Jun
- Biomedical Engineering Research Center, Asan Institute of Life Science, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul, Republic of Korea
| | - BeomHee Park
- Biomedical Engineering Research Center, Asan Institute of Life Science, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul, Republic of Korea
| | - Joon Beom Seo
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul, Republic of Korea
| | - SangMin Lee
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul, Republic of Korea
| | - Namkug Kim
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul, Republic of Korea.
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Shioya S, Masuda T, Yamaguchi K, Sakamoto S, Horimasu Y, Nakashima T, Miyamoto S, Senoo T, Iwamoto H, Ohshimo S, Fujitaka K, Hamada H, Hattori N. Comparison of anti-aminoacyl-tRNA synthetase antibody-related and idiopathic non-specific interstitial pneumonia. Respir Med 2019; 152:44-50. [PMID: 31128609 DOI: 10.1016/j.rmed.2019.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/23/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE Patients with anti-aminoacyl-tRNA synthetase (ARS) antibodies frequently experience complications of interstitial pneumonia (ARS-IP), and the computed tomography (CT) of ARS-IP frequently shows nonspecific interstitial pneumonia (NSIP) pattern. The CT pattern of ARS-IP might be different from that of idiopathic IP. However, the clinical differences in patients with ARS-IP and idiopathic IP showing the similar CT patterns have not yet been well studied. The objective of this study was to evaluate the clinical differences between patients with ARS-NSIP and idiopathic NSIP (I-NSIP). METHODS Two groups of 34 patients each, with ARS-NSIP and I-NSIP, who visited Hiroshima University Hospital between January 2005 and December 2017, were enrolled. Clinical features and outcomes were retrospectively compared between the two groups. RESULTS The ARS-NSIP group included more female patients and significantly younger patients than the I-NSIP group. The percentage of lymphocytes in bronchoalveolar lavage fluid (BALF) was significantly higher, and the CD4/CD8 ratio in BALF was significantly lower in the ARS-NSIP group compared with the I-NSIP group. The proportion of patients with traction bronchiectasis detected by CT was significantly higher in I-NSIP compared with ARS-NSIP. The number of patients who received corticosteroid and/or immunosuppressant therapy was significantly larger in the ARS-NSIP group than in the I-NSIP group. In addition, the patients in the I-NSIP group who underwent the immunosuppressive therapy demonstrated shorter survival than those who underwent no treatment; this tendency was not observed in the ARS-NSIP group. The 10-year survival rate of patients in the ARS-NSIP group was significantly higher than that of patients in the I-NSIP group (91.8% vs. 43.0%; log-rank, p = 0.012). The multivariate survival analysis revealed that positive anti-ARS antibody was an independent favorable prognostic factor in the patients with NSIP (OR, [95% CI]:0.12 [0.02-0.55], p = 0.013). CONCLUSIONS Patients with ARS-NSIP had a significantly better prognosis than those with I-NSIP; this may be associated with the sensitivity to immunosuppressive therapies, and the different findings of BALF and HRCT between the two groups.
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Affiliation(s)
- Sachiko Shioya
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Takeshi Masuda
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Kakuhiro Yamaguchi
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shinjiro Sakamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yasushi Horimasu
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Taku Nakashima
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shintaro Miyamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Tadashi Senoo
- Department of Clinical Oncology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroshi Iwamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazunori Fujitaka
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hironobu Hamada
- Department of Physical Analysis and Therapeutic Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Duarte AC, Cordeiro A, Fernandes BM, Bernardes M, Martins P, Cordeiro I, Santiago T, Seixas MI, Ribeiro AR, Santos MJ. Rituximab in connective tissue disease-associated interstitial lung disease. Clin Rheumatol 2019; 38:2001-9. [PMID: 31016581 DOI: 10.1007/s10067-019-04557-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION/OBJECTIVES To evaluate rituximab (RTX) effectiveness and safety in patients with interstitial lung disease (ILD) related to connective tissue diseases (CTD). METHODS Retrospective multicenter cohort study, including patients with CTD-ILD, followed in six Portuguese rheumatology departments until November 2018. ILD diagnosis was based on high-resolution CT (HRCT) and/or lung biopsy. Results of HRCT, pulmonary function tests, and 6-min walking test before and after RTX were compared using the Wilcoxon matched pair test. Safety, including adverse events during treatment and reasons for RTX discontinuation, was also analyzed. RESULTS A total of 49 patients were included, with rheumatoid arthritis being the commonest CTD (61.2%). The median interval between CTD onset and ILD diagnosis was 4 years (IQR 1-9.5) and median ILD duration at first RTX administration was 1 year (IQR 0-4). The median RTX treatment duration until the last follow-up was 3 years (IQR 1-6). Usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP) were the commonest patterns, occurring in 20 and 18 patients, respectively. One year after RTX first administration, there was a stabilization in carbon monoxide diffusing capacity (DLCO; mean + 5.4%, p = 0.12) and improvement in forced vital capacity (FVC; mean + 4.3%, p = 0.03), particularly in patients with NSIP. Patients with UIP had less promising results, but at 1 year, pulmonary function tests remained stable (DLCO + 2.5%, p = 0.77; FVC + 4.2%, p = 0.16). Infection was the main reason for RTX discontinuation and led to two deaths. CONCLUSIONS RTX seems to be a promising treatment for CTD-ILD patients, particularly when NSIP pattern is present. Key points • The use of rituximab in patients with interstitial lung disease related to connective tissue disease is associated with long-standing disease stability in a wide range of systemic rheumatic diseases. • Efficacy results were particularly impressive in patients with non-specific interstitial pneumonia pattern, although in a subgroup of patients with usual interstitial pneumonia pattern, disease progression was also hold with this treatment. • In a large number of patients, rituximab was used in monotherapy and as first-line treatment.
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Cecchini MJ, Hosein K, Howlett CJ, Joseph M, Mura M. Comprehensive gene expression profiling identifies distinct and overlapping transcriptional profiles in non-specific interstitial pneumonia and idiopathic pulmonary fibrosis. Respir Res 2018; 19:153. [PMID: 30111332 PMCID: PMC6094889 DOI: 10.1186/s12931-018-0857-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 08/07/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The clinical-radiographic distinction between idiopathic pulmonary fibrosis (IPF) and non-specific interstitial pneumonia (NSIP) is challenging. We sought to investigate the gene expression profiles of IPF and NSIP vs. normal controls. METHODS Gene expression from explanted lungs of patients with IPF (n = 22), NSIP (n = 10) and from normal controls (n = 11) was assessed. Microarray analysis included Significance Analysis of Microarray (SAM), Ingenuity Pathway, Gene-Set Enrichment and unsupervised hierarchical clustering analyses. Immunohistochemistry and serology of proteins of interest were conducted. RESULTS NSIP cases were significantly enriched for genes related to mechanisms of immune reaction, such as T-cell response and recruitment of leukocytes into the lung compartment. In IPF, in contrast, these involved senescence, epithelial-to-mesenchymal transition, myofibroblast differentiation and collagen deposition. Unlike the IPF group, NSIP cases exhibited a strikingly homogenous gene signature. Clustering analysis identified a subgroup of IPF patients with intermediate and ambiguous expression of SAM-selected genes, with the interesting upregulation of both NSIP-specific and senescence-related genes. Immunohistochemistry for p16, a senescence marker, on fibroblasts differentiated most IPF cases from NSIP. Serial serum levels of periostin, a senescence effector, predicted clinical progression in a cohort of patients with IPF. CONCLUSIONS Comprehensive gene expression profiling in explanted lungs identifies distinct transcriptional profiles and differentially expressed genes in IPF and NSIP, supporting the notion of NSIP as a standalone condition. Potential gene and protein markers to discriminate IPF from NSIP were identified, with a prominent role of senescence in IPF. The finding of a subgroup of IPF patients with transcriptional features of both NSIP and senescence raises the hypothesis that "senescent" NSIP may represent a risk factor to develop superimposed IPF.
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Affiliation(s)
| | - Karishma Hosein
- Division of Respirology, London Health Science Centre, Victoria Hospital, Western University, 800 Commissioners Road East Room E6-203, London, ON, N6A 5W9, Canada
| | | | | | - Marco Mura
- Division of Respirology, London Health Science Centre, Victoria Hospital, Western University, 800 Commissioners Road East Room E6-203, London, ON, N6A 5W9, Canada. .,Toronto Lung Transplant Program, University of Toronto, Toronto, Canada.
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Mango RL, Matteson EL, Crowson CS, Ryu JH, Makol A. Assessing Mortality Models in Systemic Sclerosis-Related Interstitial Lung Disease. Lung 2018; 196:409-416. [PMID: 29785507 DOI: 10.1007/s00408-018-0126-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/13/2018] [Indexed: 01/10/2023]
Abstract
PURPOSE The gender, age, and lung physiology (GAP) model, interstitial lung diseases-GAP (ILD-GAP) model, and the smoking history, age, and diffusion capacity of the lung (SADL) model were compared using a systemic sclerosis-ILD (SSc-ILD) cohort to evaluate which best determined prognosis. METHODS The models were applied to a cohort of 179 patients with SSc seen at a tertiary care center within 1 year of ILD diagnosis. Demographics, clinical characteristics, and mortality were recorded. The performance of the models was assessed using standardized mortality ratios (SMR) of observed versus predicted outcomes for calibration and concordance (c)-statistics for discrimination. RESULTS SSc-ILD patients with usual interstitial pneumonia (31, 17%) had a higher mortality than those with non-specific interstitial pneumonia (147, 83%) (hazard ratio 2.27; 95%CI 1.03-4.97). All 3 models had comparable discrimination (c = 0.72, 0.72, and 0.71, respectively). Regarding calibration, the ILD-GAP model underestimated mortality (SMR 1.50; 95%CI 1.05-2.14). Calibration was acceptable for SADL (SMR 1.00; 95%CI 0.70-1.44) and GAP (SMR 0.90; 95%CI 0.63-1.29). The SADL model underestimated mortality in Stage I ILD. CONCLUSIONS The ILD-GAP model underestimated mortality, and the SADL model underestimated mortality in certain subgroups. However, the GAP model performed well in this cohort, providing the best prognostic information for SSc-ILD.
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Affiliation(s)
- Robert L Mango
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Ashima Makol
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
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Lee SH, Park MS, Kim SY, Kim DS, Kim YW, Chung MP, Uh ST, Park CS, Park SW, Jeong SH, Park YB, Lee HL, Shin JW, Lee EJ, Lee JH, Jegal Y, Lee HK, Kim YH, Song JW, Park JS. Factors affecting treatment outcome in patients with idiopathic nonspecific interstitial pneumonia: a nationwide cohort study. Respir Res 2017; 18:204. [PMID: 29212510 PMCID: PMC5719588 DOI: 10.1186/s12931-017-0686-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/20/2017] [Indexed: 01/01/2023] Open
Abstract
Background The effects of corticosteroid-based therapy in patients with idiopathic nonspecific interstitial pneumonia (iNSIP), and factors affecting treatment outcome, are not fully understood. We aimed to investigate the long-term treatment response and factors affecting the treatment outcome in iNSIP patients from a multi-center study in Korea. Methods The Korean interstitial lung disease (ILD) Study Group surveyed ILD patients from 2003 to 2007. Patients were divided into two groups to compare the treatment response: response group (forced vital capacity (FVC) improves ≥10% after 1 year) and non-response group (FVC <10%). Factors affecting treatment response were evaluated by multivariate logistic regression analysis. Results A total of 261 patients with iNSIP were enrolled, and 95 patients were followed-up for more than 1 year. Corticosteroid treatment was performed in 86 patients. The treatment group showed a significant improvement in lung function after 1-year: FVC, 10.0%; forced expiratory volume (FEV1), 9.8%; diffusing capacity of the lung for carbon monoxide (DLco), 8.4% (p < 0.001). Sero-negative anti-nuclear antibody (ANA) was significantly related with lung function improvement. Sero-positivity ANA was significantly lower in the response group (p = 0.013), compared to that in the non-response group. A shorter duration of respiratory symptoms at diagnosis was significantly associated with a good response to treatment (p = 0.018). Conclusion Treatment with corticosteroids and/or immunosuppressants improved lung function in iNSIP patients, which was more pronounced in sero-negative ANA and shorter symptom duration patients. These findings suggest that early treatment should be considered in iNSIP patients, even in an early disease stage. Electronic supplementary material The online version of this article (10.1186/s12931-017-0686-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sang Hoon Lee
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.,Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Moo Suk Park
- Department of Internal Medicine, Division of Pulmonology, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Song Yee Kim
- Department of Internal Medicine, Division of Pulmonology, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Dong Soon Kim
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Young Whan Kim
- Department of Internal Medicine and Lung Institute, Division of Pulmonary and Critical Care Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Man Pyo Chung
- Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Soo Taek Uh
- Department of Internal Medicine, Division of Allergy and Respiratory Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - Choon Sik Park
- Department of Internal Medicine, Division of Allergy and Respiratory Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Sung Woo Park
- Department of Internal Medicine, Division of Allergy and Respiratory Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Sung Hwan Jeong
- Department of Internal Medicine, Division of Pulmonology, Gachon University Gil Medical Center, Incheon, South Korea
| | - Yong Bum Park
- Department of Internal Medicine, Division of Pulmonary, Allergy & Critical Care Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, South Korea
| | - Hong Lyeol Lee
- Department of Internal Medicine, Pulmonary Division, Inha University Hospital, Incheon, South Korea
| | - Jong Wook Shin
- Department of Internal medicine, Division of Pulmonary Medicine, Chung Ang University College of Medicine, Seoul, South Korea
| | - Eun Joo Lee
- Department of Internal Medicine, Division of Respiratory and Critical Care Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jin Hwa Lee
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Yangin Jegal
- Department of Internal Medicine, Division of Pulmonary Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Hyun Kyung Lee
- Department of Internal Medicine, Division of Critical Care and Pulmonary Medicine, Inje University Busan Paik Hospital, Busan, South Korea
| | - Yong Hyun Kim
- Department of Internal Medicine, Division of Allergy and Pulmonology, Bucheon St. Mary's Hospital, The Catholic University of Korea School of Medicine, Bucheon, South Korea
| | - Jin Woo Song
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jong Sun Park
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea.
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Ebisutani C, Ito I, Kitaichi M, Tanabe N, Mishima M, Kadowaki S. A case of non-specific interstitial pneumonia with recurrent gastric carcinoma and anti-Jo-1 antibody positive myositis. Respir Investig 2016; 54:289-93. [PMID: 27424830 DOI: 10.1016/j.resinv.2016.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 02/02/2016] [Accepted: 02/16/2016] [Indexed: 12/01/2022]
Abstract
We report the first case of non-specific interstitial pneumonia (NSIP) in a patient with cancer-associated myositis (CAM) that emerged along with the recurrence of the cancer. A 60-year-old woman, with a history of partial gastrectomy for gastric cancer 11 years ago, presented with exertional dyspnea with anti-Jo-1 antibody-positive myositis. Surgical lung biopsy showed NSIP with metastatic gastric cancer. Accordingly, her condition was diagnosed as CAM with cancer recurrence. In patients with a history of cancer, development of myositis may indicate cancer recurrence; therefore, careful observation would be necessary.
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Affiliation(s)
- Chikara Ebisutani
- Department of Internal Medicine, Ono Municipal Hospital, 323 Nakacho, Ono City, Hyogo 675-1332, Japan; Department of Gastrointestinal Medicine, Kobe Minimally Invasive Treatment Center of Cancer (KMCC), 8-5-1, Minatojima-nakamachi, Chuo-ku, Kobe City 650-0046, Japan.
| | - Isao Ito
- Department of Respiratory Medicine, Kyoto University Hospital, 54 Shogoin-kawaracho, Sakyo, Kyoto 606-8507, Japan.
| | - Masanori Kitaichi
- Department of Pathology, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180, Nagasone-cho, Kita-ku, Sakai, Osaka 591-8555, Japan.
| | - Naoya Tanabe
- Department of Respiratory Medicine, Kyoto University Hospital, 54 Shogoin-kawaracho, Sakyo, Kyoto 606-8507, Japan.
| | - Michiaki Mishima
- Department of Respiratory Medicine, Kyoto University Hospital, 54 Shogoin-kawaracho, Sakyo, Kyoto 606-8507, Japan.
| | - Seizo Kadowaki
- Department of Internal Medicine, Ono Municipal Hospital, 323 Nakacho, Ono City, Hyogo 675-1332, Japan.
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