RT Journal Article
SR Electronic
T1 Rheumatological Assessment Is Important for Interstitial Lung Disease Diagnosis
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 1509
OP 1514
DO 10.3899/jrheum.171314
VO 45
IS 11
A1 Yair Levi
A1 Lilach Israeli-Shani
A1 Michael Kuchuk
A1 Gali Epstein Shochet
A1 Matthew Koslow
A1 David Shitrit
YR 2018
UL http://www.jrheum.org/content/45/11/1509.abstract
AB Objective. Interstitial lung diseases (ILD) form a diverse group of parenchymal lung disorders. Currently, a multidisciplinary team (MDT) including pulmonologists, radiologists, and pathologists is the gold standard for ILD diagnosis. Recently, additional subtypes of connective tissue disease (CTD)-ILD with autoimmune features were defined, making the rheumatological assessment increasingly important. We aimed to assess the effect of adding a rheumatologist to the MDT for routine rheumatology assessment.Methods. A prospective study that assessed newly diagnosed ILD patients by 2 parallel blinded arms; all patients were evaluated by both MDT (e.g., history, physical examination, blood tests, pulmonary function tests, and biopsies, if needed) and a rheumatologist (e.g., history, physical examination, blood and serological tests).Results. Sixty patients were assessed with the mean age of 67.3 ± 12 years, 55% male, and 28% smokers. The rheumatological assessment reclassified 21% of the idiopathic pulmonary fibrosis as CTD. Moreover, the number of CTD-ILD with autoimmune features was increased by 77%. These included antineutrophil cytoplasmic antibody–associated vasculitis, antisynthetase syndrome, and IgG4-related ILD. Retrospectively, rheumatological evaluation could have saved 7 bronchoscopies and 1 surgical biopsy.Conclusion. Adding routine rheumatology assessments could significantly increase diagnostic accuracy and reduce invasive procedures.