Impact of a systematic evaluation of connective tissue disease on diagnosis approach in patients with interstitial lung diseases
Identifieur interne : 000131 ( Main/Exploration ); précédent : 000130; suivant : 000132Impact of a systematic evaluation of connective tissue disease on diagnosis approach in patients with interstitial lung diseases
Auteurs : Fernanda Hernandez-Gonzalez [Espagne] ; Sergio Prieto-González ; Pilar Brito-Zeron ; Sandra Cuerpo [Espagne] ; Marcelo Sanchez ; Jose Ramirez ; Carlos Agustí [Espagne] ; Carmen María Lucena [Espagne] ; Marina Paradela [Espagne] ; Ignacio Grafia ; Gerard Espinosa ; Jacobo Sellares [Espagne]Source :
- Medicine [ 0025-7974 ] ; 2020.
Abstract
To date, there is no clear agreement regarding which is the best method to detect a connective tissue disease (CTD) during the initial diagnosis of interstitial lung diseases (ILD). The aim of our study was to explore the impact of a systematic diagnostic strategy to detect CTD-associated ILD (CTD-ILD) in clinical practice, and to clarify the significance of interstitial pneumonia with autoimmune features (IPAF) diagnosis in ILD patients.
Consecutive patients evaluated in an ILD Diagnostic Program were divided in 3 groups: IPAF, CTD-ILD, and other ILD forms. Clinical characteristics, exhaustive serologic testing, high resolution computed tomography (HRCT) images, lung biopsy specimens, and follow-up were prospectively collected and analyzed.
Among 139 patients with ILD, CTD was present in 21 (15.1%), 24 (17.3%) fulfilled IPAF criteria, and 94 (67.6%) were classified as other ILD forms. Specific systemic autoimmune symptoms such as Raynaud phenomenon (19%), inflammatory arthropathy (66.7%), and skin manifestations (38.1%) were more frequent in CTD-ILD patients than in the other groups (all
This systematic diagnostic strategy was useful in discriminating an underlying CTD in patients with ILD. The defined criteria for IPAF are fulfilled by a considerable proportion of patients referred for ILD.
Url:
DOI: 10.1097/MD.0000000000018589
PubMed: 31977850
PubMed Central: 7004576
Affiliations:
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type="wicri:Area/Main/Exploration">000131</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Impact of a systematic evaluation of connective tissue disease on diagnosis approach in patients with interstitial lung diseases</title><author><name sortKey="Hernandez Gonzalez, Fernanda" sort="Hernandez Gonzalez, Fernanda" uniqKey="Hernandez Gonzalez F" first="Fernanda" last="Hernandez-Gonzalez">Fernanda Hernandez-Gonzalez</name><affiliation wicri:level="4"><nlm:aff id="aff1">Servei de Pneumologia, Hospital Clínic, IDIBAPS, Universitat de Barcelona</nlm:aff><country>Espagne</country><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName><orgName type="university">Université de Barcelone</orgName></affiliation></author><author><name sortKey="Prieto Gonzalez, Sergio" sort="Prieto Gonzalez, Sergio" uniqKey="Prieto Gonzalez S" first="Sergio" last="Prieto-González">Sergio Prieto-González</name><affiliation><nlm:aff id="aff2">Servei de Malalties Autoimmunes, Hospital Clínic</nlm:aff><wicri:noCountry code="subfield">Hospital Clínic</wicri:noCountry></affiliation></author><author><name sortKey="Brito Zeron, Pilar" sort="Brito Zeron, Pilar" uniqKey="Brito Zeron P" first="Pilar" last="Brito-Zeron">Pilar Brito-Zeron</name><affiliation><nlm:aff id="aff2">Servei de Malalties Autoimmunes, Hospital Clínic</nlm:aff><wicri:noCountry code="subfield">Hospital Clínic</wicri:noCountry></affiliation></author><author><name sortKey="Cuerpo, Sandra" sort="Cuerpo, Sandra" uniqKey="Cuerpo S" first="Sandra" last="Cuerpo">Sandra Cuerpo</name><affiliation wicri:level="4"><nlm:aff id="aff1">Servei de Pneumologia, Hospital Clínic, IDIBAPS, Universitat de Barcelona</nlm:aff><country>Espagne</country><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName><orgName type="university">Université de Barcelone</orgName></affiliation></author><author><name sortKey="Sanchez, Marcelo" sort="Sanchez, Marcelo" uniqKey="Sanchez M" first="Marcelo" last="Sanchez">Marcelo Sanchez</name><affiliation><nlm:aff id="aff3">Servicio de Radiodiagnóstico, Hospital Clínic</nlm:aff><wicri:noCountry code="subfield">Hospital Clínic</wicri:noCountry></affiliation></author><author><name sortKey="Ramirez, Jose" sort="Ramirez, Jose" uniqKey="Ramirez J" first="Jose" last="Ramirez">Jose Ramirez</name><affiliation><nlm:aff id="aff4">Servicio de Anatomía Patológica, Hospital Clínic</nlm:aff><wicri:noCountry code="subfield">Hospital Clínic</wicri:noCountry></affiliation></author><author><name sortKey="Agusti, Carlos" sort="Agusti, Carlos" uniqKey="Agusti C" first="Carlos" last="Agustí">Carlos Agustí</name><affiliation wicri:level="4"><nlm:aff id="aff1">Servei de Pneumologia, Hospital Clínic, IDIBAPS, Universitat de Barcelona</nlm:aff><country>Espagne</country><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName><orgName type="university">Université de Barcelone</orgName></affiliation></author><author><name sortKey="Lucena, Carmen Maria" sort="Lucena, Carmen Maria" uniqKey="Lucena C" first="Carmen María" last="Lucena">Carmen María Lucena</name><affiliation wicri:level="4"><nlm:aff id="aff1">Servei de Pneumologia, Hospital Clínic, IDIBAPS, Universitat de Barcelona</nlm:aff><country>Espagne</country><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName><orgName type="university">Université de Barcelone</orgName></affiliation></author><author><name sortKey="Paradela, Marina" sort="Paradela, Marina" uniqKey="Paradela M" first="Marina" last="Paradela">Marina Paradela</name><affiliation wicri:level="3"><nlm:aff id="aff5">Servei de Cirurgia Toràcica, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona</nlm:aff><country>Espagne</country><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName><wicri:orgArea>Servei de Cirurgia Toràcica, Hospital Clínic, IDIBAPS, Universitat de Barcelona</wicri:orgArea></affiliation></author><author><name sortKey="Grafia, Ignacio" sort="Grafia, Ignacio" uniqKey="Grafia I" first="Ignacio" last="Grafia">Ignacio Grafia</name><affiliation><nlm:aff id="aff2">Servei de Malalties Autoimmunes, Hospital Clínic</nlm:aff><wicri:noCountry code="subfield">Hospital Clínic</wicri:noCountry></affiliation></author><author><name sortKey="Espinosa, Gerard" sort="Espinosa, Gerard" uniqKey="Espinosa G" first="Gerard" last="Espinosa">Gerard Espinosa</name><affiliation><nlm:aff id="aff2">Servei de Malalties Autoimmunes, Hospital Clínic</nlm:aff><wicri:noCountry code="subfield">Hospital Clínic</wicri:noCountry></affiliation></author><author><name sortKey="Sellares, Jacobo" sort="Sellares, Jacobo" uniqKey="Sellares J" first="Jacobo" last="Sellares">Jacobo Sellares</name><affiliation wicri:level="4"><nlm:aff id="aff1">Servei de Pneumologia, Hospital Clínic, IDIBAPS, Universitat de Barcelona</nlm:aff><country>Espagne</country><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName><orgName type="university">Université de Barcelone</orgName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff6">Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Barcelona, Spain.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Espagne</country><wicri:regionArea>Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author></analytic><series><title level="j">Medicine</title><idno type="ISSN">0025-7974</idno><idno type="eISSN">1536-5964</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Abstract</title><p>To date, there is no clear agreement regarding which is the best method to detect a connective tissue disease (CTD) during the initial diagnosis of interstitial lung diseases (ILD). The aim of our study was to explore the impact of a systematic diagnostic strategy to detect CTD-associated ILD (CTD-ILD) in clinical practice, and to clarify the significance of interstitial pneumonia with autoimmune features (IPAF) diagnosis in ILD patients.</p><p>Consecutive patients evaluated in an ILD Diagnostic Program were divided in 3 groups: IPAF, CTD-ILD, and other ILD forms. Clinical characteristics, exhaustive serologic testing, high resolution computed tomography (HRCT) images, lung biopsy specimens, and follow-up were prospectively collected and analyzed.</p><p>Among 139 patients with ILD, CTD was present in 21 (15.1%), 24 (17.3%) fulfilled IPAF criteria, and 94 (67.6%) were classified as other ILD forms. Specific systemic autoimmune symptoms such as Raynaud phenomenon (19%), inflammatory arthropathy (66.7%), and skin manifestations (38.1%) were more frequent in CTD-ILD patients than in the other groups (all <italic>P</italic> < .001). Among autoantibodies, antinuclear antibody was the most frequently found in IPAF (42%), and CTD-ILD (40%) (<italic>P</italic> = .04). Nonspecific interstitial pneumonia, detected by HRCT scan, was the most frequently seen pattern in patients with IPAF (63.5%), or CTD-ILD (57.1%) (<italic>P</italic> < .001). In multivariate analysis, a suggestive radiological pattern by HRCT scan (odds ratio [OR] 15.1, 95% confidence interval [CI] 4.7–48.3, <italic>P</italic> < .001) was the strongest independent predictor of CTD-ILD or IPAF, followed by the presence of clinical features (OR 14.6, 95% CI 4.3–49.5, <italic>P</italic> < .001), and serological features (OR 12.4, 95% CI 3.5–44.0, <italic>P</italic> < .001).</p><p>This systematic diagnostic strategy was useful in discriminating an underlying CTD in patients with ILD. The defined criteria for IPAF are fulfilled by a considerable proportion of patients referred for ILD.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Fischer, A" uniqKey="Fischer A">A Fischer</name></author><author><name sortKey="Brown, Kk" uniqKey="Brown K">KK Brown</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Danieli, Mg" uniqKey="Danieli M">MG Danieli</name></author><author><name sortKey="Fraticelli, P" uniqKey="Fraticelli P">P Fraticelli</name></author><author><name sortKey="Salvi, A" uniqKey="Salvi A">A Salvi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Corte, Tj" uniqKey="Corte T">TJ Corte</name></author><author><name sortKey="Copley, Sj" uniqKey="Copley S">SJ Copley</name></author><author><name sortKey="Desai, Sr" uniqKey="Desai S">SR Desai</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Flaherty, Kr" 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Chae</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Espagne</li></country><region><li>Catalogne</li></region><settlement><li>Barcelone</li></settlement><orgName><li>Université de Barcelone</li></orgName></list><tree><noCountry><name sortKey="Brito Zeron, Pilar" sort="Brito Zeron, Pilar" uniqKey="Brito Zeron P" first="Pilar" last="Brito-Zeron">Pilar Brito-Zeron</name><name sortKey="Espinosa, Gerard" sort="Espinosa, Gerard" uniqKey="Espinosa G" first="Gerard" last="Espinosa">Gerard Espinosa</name><name sortKey="Grafia, Ignacio" sort="Grafia, Ignacio" uniqKey="Grafia I" first="Ignacio" last="Grafia">Ignacio Grafia</name><name sortKey="Prieto Gonzalez, Sergio" sort="Prieto Gonzalez, Sergio" uniqKey="Prieto Gonzalez S" first="Sergio" last="Prieto-González">Sergio Prieto-González</name><name sortKey="Ramirez, Jose" sort="Ramirez, Jose" uniqKey="Ramirez J" first="Jose" last="Ramirez">Jose Ramirez</name><name sortKey="Sanchez, Marcelo" sort="Sanchez, Marcelo" uniqKey="Sanchez M" first="Marcelo" last="Sanchez">Marcelo Sanchez</name></noCountry><country name="Espagne"><region name="Catalogne"><name sortKey="Hernandez Gonzalez, Fernanda" sort="Hernandez Gonzalez, Fernanda" uniqKey="Hernandez Gonzalez F" first="Fernanda" last="Hernandez-Gonzalez">Fernanda Hernandez-Gonzalez</name></region><name sortKey="Agusti, Carlos" sort="Agusti, Carlos" uniqKey="Agusti C" first="Carlos" last="Agustí">Carlos Agustí</name><name sortKey="Cuerpo, Sandra" sort="Cuerpo, Sandra" uniqKey="Cuerpo S" first="Sandra" last="Cuerpo">Sandra Cuerpo</name><name sortKey="Lucena, Carmen Maria" sort="Lucena, Carmen Maria" uniqKey="Lucena C" first="Carmen María" last="Lucena">Carmen María Lucena</name><name sortKey="Paradela, Marina" sort="Paradela, Marina" uniqKey="Paradela M" first="Marina" last="Paradela">Marina Paradela</name><name sortKey="Sellares, Jacobo" sort="Sellares, Jacobo" uniqKey="Sellares J" first="Jacobo" last="Sellares">Jacobo Sellares</name><name sortKey="Sellares, Jacobo" sort="Sellares, Jacobo" uniqKey="Sellares J" first="Jacobo" last="Sellares">Jacobo Sellares</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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