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2020-01-01

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cc-by (c) Hernández González, Fernanda et al., 2020
Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/173968

Impact of a systematic evaluation of connective tissue disease on diagnosis approach in patients with interstitial lung diseases

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https://doi.org/10.1097/MD.0000000000018589

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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 P< .001). Among autoantibodies, antinuclear antibody was the most frequently found in IPAF (42%), and CTD-ILD (40%) (P= .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%) (P< .001). In multivariate analysis, a suggestive radiological pattern by HRCT scan (odds ratio [OR] 15.1, 95% confidence interval [CI] 4.7-48.3, P< .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, P< .001), and serological features (OR 12.4, 95% CI 3.5-44.0, P< .001). 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.

Matèries

Malalties del pulmó, Diagnòstic, Malalties autoimmunitàries

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Pulmonary diseases, Diagnosis, Autoimmune diseases

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Articles publicats en revistes (Fonaments Clínics)
Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)

Citació

HERNÁNDEZ GONZÁLEZ, Fernanda, PRIETO GONZÁLEZ, Sergio, BRITO ZERÓN, María del pilar, CUERPO CARDEÑOSA, Sandra, SÁNCHEZ, Marcelo, RAMÍREZ RUZ, J. (josé), AGUSTÍ GARCÍA-NAVARRO, Carles, LUCENA, Carmen m., PARADELA, Marina, GRAFIA, Ignacio, ESPINOSA GARRIGA, Gerard, SELLARÉS TORRES, Jacobo. Impact of a systematic evaluation of connective tissue disease on diagnosis approach in patients with interstitial lung diseases. _Medicine_. 2020. Vol. 99, núm. 4, pàgs. e18589. [consulta: 20 de gener de 2026]. ISSN: 0025-7974. [Disponible a: https://hdl.handle.net/2445/173968]

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