Early detection of interstitial lung disease in rheumatic diseases: A joint statement from the Portuguese Pulmonology Society, the Portuguese Rheumatology Society, and the Portuguese Radiology and Nuclear Medicine Society

A Morais; A C Duarte; M O Fernandes; A Borba; C Ruano; I D Marques; J Calha; J C Branco; J M Pereira; M J Salvador; M Bernardes; N Khmelinskii; P Pinto; R Pinto-Basto; S Freitas; S Campainha; T Alfaro; A Cordeiro

doi:10.1016/j.pulmoe.2023.11.007

Early detection of interstitial lung disease in rheumatic diseases: A joint statement from the Portuguese Pulmonology Society, the Portuguese Rheumatology Society, and the Portuguese Radiology and Nuclear Medicine Society

Pulmonology. 2023 Dec 25:S2531-0437(23)00205-2. doi: 10.1016/j.pulmoe.2023.11.007. Online ahead of print.

Authors

A Morais¹, A C Duarte², M O Fernandes³, A Borba⁴, C Ruano⁵, I D Marques⁶, J Calha⁷, J C Branco⁷, J M Pereira⁸, M J Salvador⁹, M Bernardes¹⁰, N Khmelinskii¹¹, P Pinto¹², R Pinto-Basto¹³, S Freitas¹⁴, S Campainha¹⁵, T Alfaro¹⁴, A Cordeiro²

Affiliations

¹ Pulmonology Department, Hospital de São João, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; i3S - Instituto de Biologia Molecular e Celular/Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal; Portuguese Pulmonology Society (SPP). Electronic address: antonio.morais16@outlook.com.
² Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal; Portuguese Rheumatology Society (SPR).
³ Imaging Department, Hospital de Santa Marta, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal; Imaging Department, Hospital da Luz Lisboa, Lisboa, Portugal; Portuguese Rheumatology Society (SPR); Portuguese Radiology and Nuclear Medicine Society (SPRMN).
⁴ Pulmonology Department, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal; Portuguese Pulmonology Society (SPP).
⁵ Imaging Department, Hospital de Santa Marta, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal; Imaging Department, Hospital da Luz Lisboa, Lisboa, Portugal; Portuguese Radiology and Nuclear Medicine Society (SPRMN).
⁶ Imaging Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Portuguese Radiology and Nuclear Medicine Society (SPRMN).
⁷ Imaging Department, Hospital Beatriz Ângelo, Loures, Portugal; Imaging Department, Hospital da Luz Lisboa, Lisboa, Portugal; Portuguese Radiology and Nuclear Medicine Society (SPRMN).
⁸ Imaging Department, Hospital de São João, Centro Hospitalar Universitário São João, Porto, Portugal; Imaging Department, Unilabs Portugal, Porto, Portugal; Portuguese Radiology and Nuclear Medicine Society (SPRMN).
⁹ Rheumatology Department Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Portuguese Rheumatology Society (SPR).
¹⁰ Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal; Rheumatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
¹¹ Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisboa, Portugal; Portuguese Rheumatology Society (SPR).
¹² Rheumatology Department, Centro Hospitalar Vila Nova de Gaia/ Espinho, Vila Nova de Gaia, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; Portuguese Rheumatology Society (SPR).
¹³ Pulmonology Department, Hospital Pulido Valente, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; Portuguese Pulmonology Society (SPP).
¹⁴ Pulmonology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Portuguese Pulmonology Society (SPP).
¹⁵ Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Portuguese Pulmonology Society (SPP).

PMID: 38148269
DOI: 10.1016/j.pulmoe.2023.11.007

Abstract

Introduction: Interstitial lung disease (ILD) contributes significantly to morbidity and mortality in connective tissue disease (CTD). Early detection and accurate diagnosis are essential for informing treatment decisions and prognosis in this setting. Clear guidance on CTD-ILD screening, however, is lacking.

Objective: To establish recommendations for CTD-ILD screening based on the current evidence.

Method: Following an extensive literature research and evaluation of articles selected for their recency and relevance to the characterization, screening, and management of CTD-ILD, an expert panel formed by six pulmonologists from the Portuguese Society of Pulmonology, six rheumatologists from the Portuguese Society of Rheumatology, and six radiologists from the Portuguese Society of Radiology and Nuclear Medicine participated in a multidisciplinary discussion to produce a joint statement on screening recommendations for ILD in CTD.

Results: The expert panel achieved consensus on when and how to screen for ILD in patients with systemic sclerosis, rheumatoid arthritis, mixed connective tissue disease, Sjögren syndrome, idiopathic inflammatory myopathies and systemic lupus erythematous.

Conclusions: Despite the lack of data on screening for CTD-ILD, an expert panel of pulmonologists, rheumatologists and radiologists agreed on a series of screening recommendations to support decision-making and enable early diagnosis of ILD to ultimately improve outcomes and prognosis in patients with CTD.

Keywords: CTD-ILD; Connective tissue diseases; Consensus statement; Early diagnosis; Interstitial lung diseases; Lung fibrosis; Screening.