2023 ACR/CHEST Guideline: Screening & Monitoring ILD in Systemic Autoimmune Rheumatic Diseases

At December 04, 2024

"2023 American College of Rheumatology (ACR)/American College of Chest Physicians (CHEST) Guideline for the Screening and Monitoring of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Diseases"

Arthritis Rheumatol. 2024 Aug;76(8):1201-1213. doi: 10.1002/art.42860.Epub 2024 Jul 8.

Sindhu R Johnson 1, Elana J Bernstein 2, Marcy B Bolster 3, Jonathan H Chung 4, Sonye K Danoff 5, Michael D George 6, Dinesh Khanna 7, Gordon Guyatt 8, Reza D Mirza 8, Rohit Aggarwal 9, Aberdeen Allen Jr 10, Shervin Assassi 11, Lenore Buckley 12, Hassan A Chami 5, Douglas S Corwin 13, Paul F Dellaripa 14, Robyn T Domsic 9, Tracy J Doyle 14, Catherine Marie Falardeau 15, Tracy M Frech 16, Fiona K Gibbons 3, Monique Hinchcliff 12, Cheilonda Johnson 6, Jeffrey P Kanne 17, John S Kim 18, Sian Yik Lim 19, Scott Matson 20, Zsuzsanna H McMahan 5, Samantha J Merck 21, Kiana Nesbitt 22, Mary Beth Scholand 23, Lee Shapiro 24, Christine D Sharkey 17, Ross Summer 25, John Varga 7, Anil Warrier 26, Sandeep K Agarwal 27, Danielle Antin-Ozerkis 12, Bradford Bemiss 28, Vaidehi Chowdhary 12, Jane E Dematte D'Amico 28, Robert Hallowell 3, Alicia M Hinze 29, Patil A Injean 30, Nikhil Jiwrajka 6, Elena K Joerns 31, Joyce S Lee 32, Ashima Makol 29, Gregory C McDermott 14, Jake G Natalini 33, Justin M Oldham 7, Didem Saygin 9, Kimberly Showalter Lakin 34, Namrata Singh 35, Joshua J Solomon 36, Jeffrey A Sparks 14, Marat Turgunbaev 37, Samera Vaseer 38, Amy Turner 37, Stacey Uhl 39, Ilya Ivlev 39

Affiliations

• 1 University of Toronto, Schroeder Arthritis Institute, Toronto Western Hospital, Mount Sinai Hospital, Toronto, Ontario, Canada.
• 2 Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York City.
• 3 Massachusetts General Hospital, Boston.
• 4 The University of Chicago Medicine, Chicago, Illinois.
• 5 Johns Hopkins University School of Medicine, Baltimore, Maryland.
• 6 University of Pennsylvania, Philadelphia.
• 7 University of Michigan, Ann Arbor.
• 8 McMaster University, Hamilton, Ontario, Canada.
• 9 University of Pittsburgh, Pittsburgh, Pennsylvania.
• 10 Parlin, New Jersey.
• 11 University of Texas Health Science Center at Houston.
• 12 Yale School of Medicine, New Haven, Connecticut.
• 13 St. Luke's University Health Network, Bethlehem, Pennsylvania.
• 14 Brigham and Women's Hospital, Boston, Massachusetts.
• 15 Kissimmee, Florida.
• 16 Vanderbilt University Medical Center, Nashville, Tennessee.
• 17 University of Wisconsin School of Medicine and Public Health, Madison.
• 18 University of Virginia School of Medicine, Charlottesville.
• 19 Hawaii Pacific Health, Aiea.
• 20 University of Kansas Medical Center, Kansas City.
• 21 Saint Francis Health System, Tulsa, Oklahoma.
• 22 Lansdowne, Pennsylvania.
• 23 University of Utah, Salt Lake City.
• 24 Albany Medical College, Albany, New York.
• 25 Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
• 26 Millennium Physicians, Huntsville, Texas.
• 27 Baylor College of Medicine, Houston, Texas.
• 28 Northwestern University, Chicago, Illinois.
• 29 Mayo Clinic, Rochester, Minnesota.
• 30 Cedars-Sinai, Los Angeles, California.
• 31 UT Southwestern Medical Center, Dallas, Texas.
• 32 University of Colorado Denver, Aurora.
• 33 New York University Langone Health, New York City.
• 34 Hospital for Special Surgery, Weill Cornell Medicine, New York City.
• 35 University of Washington, Seattle.
• 36 National Jewish Health, Denver, Colorado.
• 37 American College of Rheumatology, Atlanta, Georgia.
• 38 University of Oklahoma, Oklahoma City.
• 39 ECRI, Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania.

Abstract

Objective: We provide evidence-based recommendations regarding screening for interstitial lung disease (ILD) and the monitoring for ILD progression in people with systemic autoimmune rheumatic diseases (SARDs), specifically rheumatoid arthritis, systemic sclerosis, idiopathic inflammatory myopathies, mixed connective tissue disease, and Sjögren disease.

Methods: We developed clinically relevant population, intervention, comparator, and outcomes questions related to screening and monitoring for ILD in patients with SARDs. A systematic literature review was performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology. A Voting Panel of interdisciplinary clinician experts and patients achieved consensus on the direction and strength of each recommendation.

Results: Fifteen recommendations were developed. For screening people with these SARDs at risk for ILD, we conditionally recommend pulmonary function tests (PFTs) and high-resolution computed tomography of the chest (HRCT chest); conditionally recommend against screening with 6-minute walk test distance (6MWD), chest radiography, ambulatory desaturation testing, or bronchoscopy; and strongly recommend against screening with surgical lung biopsy. We conditionally recommend monitoring ILD with PFTs, HRCT chest, and ambulatory desaturation testing and conditionally recommend against monitoring with 6MWD, chest radiography, or bronchoscopy. We provide guidance on ILD risk factors and suggestions on frequency of testing to evaluate for the development of ILD in people with SARDs.

Conclusion: This clinical practice guideline presents the first recommendations endorsed by the American College of Rheumatology and American College of Chest Physicians for the screening and monitoring of ILD in people with SARDs.

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ANCHOR-RA: Multi-National Cross-Sectional Study on ILD Screening in Rheumatoid Arthritis Patients

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RA-ILD: Update on Prevalence, Risk Factors, Pathogenesis, and Therapy

Curr Rheumatol Rep. 2024 Sep 25. doi: 10.1007/s11926-024-01155-8. Online ahead of print. Daniel I Sullivan 1, Dana P Ascherman 2 Affiliations • 1Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh, UPMC Montefiore Hospital, 3459 Fifth Ave, NW 628, Pittsburgh, PA, 15213, USA. dsulliva@pitt.edu. • 2Division of Rheumatology and Clinical Immunology, Department of Medicine, Abstract Purpose of review: Rheumatoid arthritis is frequently complicated by interstitial lung disease (RA-ILD), an underappreciated contributor to excess morbidity and mortality. The true prevalence of RA-ILD is difficult to define given the variability in diagnostic criteria used. The lack of standardized screening methods, an incomplete understanding of disease pathogenesis, and dearth of validated biomarkers have limited the development of controlled clinical trials for this disease. Recent findings: Numerous studies have focused on clinical, radiographic, genetic, molecular, and/or serologic markers of disease severity as well as risk of disease progression. In addition to defining valuable clinical biomarkers, these studies have provided insights regarding the pathogenesis of RA-ILD and potential therapeutic targets. Additional studies involving immunomodulatory and/or anti-fibrotic agents have assessed new therapeutic options for different stages of RA-ILD. RA-ILD continues to be a major contributor to the increased morbidity and mortality associated with RA. Advancements in our understanding of disease pathogenesis at a molecular level are necessary to drive the development of more targeted therapy.