Impact of a systematic evaluation of connective tissue disease on diagnosis approach in patients with interstitial lung diseases
Identifieur interne : 000696 ( Pmc/Curation ); précédent : 000695; suivant : 000697Impact 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
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Sergio Prieto-González<affiliation><nlm:aff id="aff2">Servei de Malalties Autoimmunes, Hospital Clínic</nlm:aff>
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Le document en format XML
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<series><title level="j">Medicine</title>
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<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>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Medicine (Baltimore)</journal-id>
<journal-id journal-id-type="iso-abbrev">Medicine (Baltimore)</journal-id>
<journal-id journal-id-type="publisher-id">MEDI</journal-id>
<journal-title-group><journal-title>Medicine</journal-title>
</journal-title-group>
<issn pub-type="ppub">0025-7974</issn>
<issn pub-type="epub">1536-5964</issn>
<publisher><publisher-name>Wolters Kluwer Health</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">31977850</article-id>
<article-id pub-id-type="pmc">7004576</article-id>
<article-id pub-id-type="publisher-id">MD-D-19-07317</article-id>
<article-id pub-id-type="doi">10.1097/MD.0000000000018589</article-id>
<article-id pub-id-type="art-access-id">18589</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>6700</subject>
</subj-group>
<subj-group><subject>Research Article</subject>
<subject>Observational Study</subject>
</subj-group>
</article-categories>
<title-group><article-title>Impact of a systematic evaluation of connective tissue disease on diagnosis approach in patients with interstitial lung diseases</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Hernandez-Gonzalez</surname>
<given-names>Fernanda</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff1"><sup>a</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Prieto-González</surname>
<given-names>Sergio</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff2"><sup>b</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Brito-Zeron</surname>
<given-names>Pilar</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff2"><sup>b</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Cuerpo</surname>
<given-names>Sandra</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff1"><sup>a</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sanchez</surname>
<given-names>Marcelo</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff3"><sup>c</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ramirez</surname>
<given-names>Jose</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff4"><sup>d</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Agustí</surname>
<given-names>Carlos</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff1"><sup>a</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lucena</surname>
<given-names>Carmen María</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff1"><sup>a</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Paradela</surname>
<given-names>Marina</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff5"><sup>e</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Grafia</surname>
<given-names>Ignacio</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff2"><sup>b</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Espinosa</surname>
<given-names>Gerard</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff2"><sup>b</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sellares</surname>
<given-names>Jacobo</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="aff1"><sup>a</sup>
</xref>
<xref ref-type="aff" rid="aff6"><sup>f</sup>
</xref>
<xref rid="cor1" ref-type="corresp"><sup>∗</sup>
</xref>
</contrib>
</contrib-group>
<contrib-group><contrib contrib-type="editor"><name><surname>Carubbi.</surname>
<given-names>Francesco</given-names>
</name>
</contrib>
</contrib-group>
<aff id="aff1"><label>a</label>
Servei de Pneumologia, Hospital Clínic, IDIBAPS, Universitat de Barcelona</aff>
<aff id="aff2"><label>b</label>
Servei de Malalties Autoimmunes, Hospital Clínic</aff>
<aff id="aff3"><label>c</label>
Servicio de Radiodiagnóstico, Hospital Clínic</aff>
<aff id="aff4"><label>d</label>
Servicio de Anatomía Patológica, Hospital Clínic</aff>
<aff id="aff5"><label>e</label>
Servei de Cirurgia Toràcica, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona</aff>
<aff id="aff6"><label>f</label>
Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Barcelona, Spain.</aff>
<author-notes id="cor1"><corresp><label>∗</label>
Correspondence: Jacobo Sellares, Servei de Pneumología, Hospital Clínic, Villarroel 170 (08036) Barcelona, Spain (e-mail: <email>sellares@clinic.cat</email>
).</corresp>
</author-notes>
<pub-date pub-type="collection"><month>1</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub"><day>24</day>
<month>1</month>
<year>2020</year>
</pub-date>
<volume>99</volume>
<issue>4</issue>
<elocation-id>e18589</elocation-id>
<history><date date-type="received"><day>16</day>
<month>9</month>
<year>2019</year>
</date>
<date date-type="rev-recd"><day>18</day>
<month>11</month>
<year>2019</year>
</date>
<date date-type="accepted"><day>03</day>
<month>12</month>
<year>2019</year>
</date>
</history>
<permissions><copyright-statement>Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.</copyright-statement>
<copyright-year>2020</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0"><license-p>This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/4.0">http://creativecommons.org/licenses/by-nc/4.0</ext-link>
</license-p>
</license>
</permissions>
<self-uri xlink:type="simple" xlink:href="medi-99-e18589.pdf"></self-uri>
<abstract><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>
</abstract>
<kwd-group><title>Keywords</title>
<kwd>autoimmune disease</kwd>
<kwd>idiopathic interstitial pneumonias</kwd>
<kwd>interstitial pneumonia</kwd>
<kwd>nonspecific interstitial pneumonia</kwd>
<kwd>undifferentiated connective tissue disease</kwd>
</kwd-group>
<custom-meta-group><custom-meta><meta-name>OPEN-ACCESS</meta-name>
<meta-value>TRUE</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
</pmc>
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