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Roofeh D, Brown KK, Kazerooni EA, Tashkin D, Assassi S, Martinez F, Wells AU, Raghu G, Denton CP, Chung L, Hoffmann-Vold AM, Distler O, Johannson KA, Allanore Y, Matteson EL, Kawano-Dourado L, Pauling JD, Seibold JR, Volkmann ER, Walsh SLF, Oddis CV, White ES, Barratt SL, Bernstein EJ, Domsic RT, Dellaripa PF, Conway R, Rosas I, Bhatt N, Hsu V, Ingegnoli F, Kahaleh B, Garcha P, Gupta N, Khanna S, Korsten P, Lin C, Mathai SC, Strand V, Doyle TJ, Steen V, Zoz DF, Ovalles-Bonilla J, Rodriguez-Pinto I, Shenoy PD, Lewandoski A, Belloli E, Lescoat A, Nagaraja V, Ye W, Huang S, Maher T, Khanna D. Systemic sclerosis associated interstitial lung disease: a conceptual framework for subclinical, clinical and progressive disease. Rheumatology (Oxford) 2023; 62:1877-1886. [PMID: 36173318 PMCID: PMC10152284 DOI: 10.1093/rheumatology/keac557] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 04/17/2022] [Revised: 08/05/2022] [Accepted: 09/17/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To establish a framework by which experts define disease subsets in systemic sclerosis associated interstitial lung disease (SSc-ILD). METHODS A conceptual framework for subclinical, clinical and progressive ILD was provided to 83 experts, asking them to use the framework and classify actual SSc-ILD patients. Each patient profile was designed to be classified by at least four experts in terms of severity and risk of progression at baseline; progression was based on 1-year follow-up data. A consensus was reached if ≥75% of experts agreed. Experts provided information on which items were important in determining classification. RESULTS Forty-four experts (53%) completed the survey. Consensus was achieved on the dimensions of severity (75%, 60 of 80 profiles), risk of progression (71%, 57 of 80 profiles) and progressive ILD (60%, 24 of 40 profiles). For profiles achieving consensus, most were classified as clinical ILD (92%), low risk (54%) and stable (71%). Severity and disease progression overlapped in terms of framework items that were most influential in classifying patients (forced vital capacity, extent of lung involvement on high resolution chest CT [HRCT]); risk of progression was influenced primarily by disease duration. CONCLUSIONS Using our proposed conceptual framework, international experts were able to achieve a consensus on classifying SSc-ILD patients along the dimensions of disease severity, risk of progression and progression over time. Experts rely on similar items when classifying disease severity and progression: a combination of spirometry and gas exchange and quantitative HRCT.
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Affiliation(s)
- David Roofeh
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
| | - Kevin K Brown
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Ella A Kazerooni
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Donald Tashkin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Shervin Assassi
- Department of Internal Medicine, Division of Rheumatology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Fernando Martinez
- Department of Internal Medicine, Division of Pulmonary Critical Care Medicine, Weill Cornell School of Medicine, New York, NY, USA
| | - Athol U Wells
- Department of Internal Medicine, Division of Pulmonology, Royal Brompton Hospital and National Heart and Lung Institute, London, UK
| | - Ganesh Raghu
- Department of Internal Medicine, Division of Pulmonology, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Christopher P Denton
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Lorinda Chung
- Department of Internal Medicine, Division of Immunology and Rheumatology, Stanford University, and Palo Alto VA Health Care System, Palo Alto, CA, USA
| | | | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kerri A Johannson
- Departments of Medicine and Community Health Sciences, Section of Respiratory Medicine, University of Calgary, Calgary, Canada
| | - Yannick Allanore
- Department of Rheumatology A, Cochin Hospital, APHP, Université de Paris, Paris, France
| | - Eric L Matteson
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Leticia Kawano-Dourado
- HCor Research Institute, Hospital do Coração, São Paulo, Brazil
- Pulmonary Division, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
- INSERM 1152, University of Paris, Paris, France
| | - John D Pauling
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Rheumatology, North Bristol NHS Trust, Southmead, Bristol, UK
| | | | - Elizabeth R Volkmann
- Department of Internal Medicine, Division of Rheumatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Simon L F Walsh
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Chester V Oddis
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Eric S White
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Shaney L Barratt
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Southmead, Bristol, UK
| | - Elana J Bernstein
- Department of Internal Medicine, Division of Rheumatology, Columbia University School of Medicine, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Robyn T Domsic
- Department of Internal Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Paul F Dellaripa
- Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard Conway
- Department of Internal Medicine, Division of Rheumatology, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Ivan Rosas
- Department of Internal Medicine, Division of Pulmonology, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Nitin Bhatt
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vivien Hsu
- Department of Internal Medicine, Division of Rheumatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Francesca Ingegnoli
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milano, Italy
| | - Bashar Kahaleh
- Department of Internal Medicine, Division of Rheumatology, University of Toledo Medical Center, Toledo, OH, USA
| | - Puneet Garcha
- Department of Internal Medicine, Division of Pulmonology, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Nishant Gupta
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Surabhi Khanna
- Department of Internal Medicine, Division of Rheumatology, University of Cincinnati, Cincinnati, OH, USA
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Celia Lin
- Genentech, Inc, San Francisco, CA, USA
| | - Stephen C Mathai
- Department of Internal Medicine, Division of Pulmonology, Critical Care and Sleep Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vibeke Strand
- Department of Internal Medicine, Division of Immunology and Rheumatology, Stanford University, Palo Alto, CA, USA
| | - Tracy J Doyle
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Virginia Steen
- Department of Internal Medicine, Division of Rheumatology, Georgetown University School of Medicine, Washington, DC, USA
| | - Donald F Zoz
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Juan Ovalles-Bonilla
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ignasi Rodriguez-Pinto
- Autoimmune Disease Unit. Deaprtment of Internal Medicine. Hospital Mutua de Terrassa, University of Barcelona, Barcelona, Spain
| | - Padmanabha D Shenoy
- Department of Rheumatology, Center for Arthritis and Rheumatism Excellence, Kochi, Kerala, India
| | - Andrew Lewandoski
- Department of Internal Medicine, Division of Rheumatology, University of Michigan-Metro Health, Grand Rapids, MI, USA
| | - Elizabeth Belloli
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Alain Lescoat
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Vivek Nagaraja
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
| | - Wen Ye
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Suiyuan Huang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Toby Maher
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dinesh Khanna
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
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