De Lorenzis Enrico, Bosello Silvia Laura, Varone Francesco, Sgalla Giacomo, Calandriello Lucio, Natalello Gerlando, Iovene Bruno, Cicchetti Giuseppe, Gigante Laura, Verardi Lucrezia, Gremese Elisa, Richeldi Luca, Larici Anna Rita
Institute of Rheumatology, Catholic University of the Sacred Heart, 00168 Rome, Italy.
Ph.D. program in Biomolecular Medicine-Cycle XXXV, University of Verona, 37129 Verona, Italy.
Diagnostics (Basel). 2020 Sep 2;10(9):664. doi: 10.3390/diagnostics10090664.
Multidisciplinary team (MDT) discussion is the gold standard in the management of interstitial lung disease (ILD). The rheumatologist is not routinely involved in MDT, even if up to 20% of ILD are related to systemic autoimmune rheumatic diseases (SARD). The study aims to assess the agreement and its variation over time between rheumatologists and pulmonologists in the screening of SARD and between rheumatologists and an MDT extended to rheumatologists (eMDT) in evaluating the progression of SARD. We computed the agreement between the pulmonologist and rheumatologist in the identification of red flags for SARDs of 81 ILD cases and between the rheumatologist alone and eMDT in the confirmation of 70 suspected SARD-ILD progressions. The agreement between rheumatologists and pulmonologists was moderate for the detection of autoimmunity test positivity ( = 0.475, < 0.001) and family history of SARD ( = 0.491, < 0.001) and fair for the identification of extrapulmonary symptoms ( = 0.225, = 0.064) or routine laboratory abnormalities consistent with SARD. The average agreement between the rheumatologist and eMDT in the identification of ILD progression was moderate ( = 0.436, < 0.001). The class of agreement improved from the first to the third semester. The average agreement with the rheumatologist ranged from fair to moderate, suggesting that a shared evaluation of SARD-ILD in eMDT could improve the diagnostic work-up and the evaluation of ILD progression.
多学科团队（MDT）讨论是间质性肺疾病（ILD）管理的金标准。即使高达20%的ILD与系统性自身免疫性风湿性疾病（SARD）相关，风湿病学家通常也不参与MDT。本研究旨在评估风湿病学家和肺科医生在筛查SARD方面的一致性及其随时间的变化，以及风湿病学家与扩展至包括风湿病学家的MDT（eMDT）在评估SARD进展方面的一致性。我们计算了肺科医生和风湿病学家在识别81例ILD病例的SARD红旗征方面的一致性，以及仅风湿病学家与eMDT在确认70例疑似SARD-ILD进展方面的一致性。风湿病学家和肺科医生在检测自身免疫试验阳性（κ = 0.475，P < 0.001）和SARD家族史（κ = 0.491，P < 0.001）方面的一致性为中等，在识别肺外症状（κ = 0.225，P = 0.064）或与SARD一致的常规实验室异常方面的一致性为一般。风湿病学家与eMDT在识别ILD进展方面的平均一致性为中等（κ = 0.436，P < 0.001）。一致性类别从第一学期到第三学期有所改善。与风湿病学家的平均一致性范围从一般到中等，这表明在eMDT中对SARD-ILD进行共同评估可以改善诊断检查和ILD进展评估。
