Diagnosing Interstitial Lung Diseases: Rheumatologists Should Be Involved
The addition of a rheumatologist to a multidisciplinary team that diagnoses interstitial lung diseases (ILD) can lead to a more accurate diagnosis and reduce the rate of invasive procedures, according to a new study.
Pulmonologists, radiologists, and pathologists are most often the specialists on a multidisciplinary team for ILD diagnosis. However, a rheumatological assessment has become more important since additional subtypes of connective tissue disease (CTD)-ILD with autoimmune features have been identified.
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In determining whether rheumatologists could be useful, the researchers assessed 60 participants with newly diagnosed ILD in 2 parallel blinded arms. A multidisciplinary team evaluated all the participants with physical examinations, blood tests, pulmonary function tests, and, if needed, biopsies. All of the participants also underwent physical examinations, as well as blood and serological testing, with a rheumatologist.
Results indicated that the rheumatological assessment reclassified 21% of the idiopathic pulmonary fibrosis as CTD. The number of CTD-ILD cases with autoimmune features, such as antisynthetase syndrome and antineutrophil cytoplasmic antibody–associated vasculitis, increased by 77%.
The researchers also determined that a rheumatological evaluation could have prevented 7 bronchoscopies and 1 surgical biopsy.
“Adding routine rheumatology assessments could significantly increase diagnostic accuracy and reduce invasive procedures,” the researchers concluded.
—Colleen Murphy
Reference:
Levi Y, Israeli-Shani L, Kuchuk M, Shochet GE, Koslow M, Shitrit D. Rheumatological assessment Is important for interstitial lung disease diagnosis. J Rheumatol. 2018; 45(11):1509-1514. https://doi.org/10.3899/jrheum.171314.