Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan.
Scleroderma/Myositis Center of Excellence, Nippon Medical School Hospital, Tokyo, Japan.
Expert Rev Respir Med. 2023 May;17(5):397-411. doi: 10.1080/17476348.2023.2215433. Epub 2023 May 24.
Interstitial lung disease (ILD) is the leading cause of mortality in idiopathic inflammatory myopathies or myositis. Clinical characteristics, including the course of ILD, rate of progression, radiological and pathohistological morphologies, extent and distribution of inflammation and fibrosis, responses to treatment, recurrence rate, and prognosis, are highly variable among myositis patients. A standard practice for ILD management in myositis patients has not yet been established.
Recent studies have demonstrated the stratification of patients with myositis-associated ILD into more homogeneous groups based on the disease behavior and myositis-specific autoantibody (MSA) profile, leading to better prognoses and prevention of the burden of organ damage. This review introduces a new paradigm in the management of myositis-associated ILD based on research findings from relevant literature selected by a search of PubMed as of January 2023, as well as expert opinions.
Managing strategies for myositis-associated ILD are being established to stratify patients based on the severity of ILD and the prediction of prognosis based on the disease behavior and MSA profile. The development of a precision medicine treatment approach will provide benefits to all relevant communities.
间质性肺病(ILD)是特发性炎症性肌病或肌炎患者死亡的主要原因。ILD 的临床特征,包括疾病过程、进展速度、影像学和组织病理学形态、炎症和纤维化的范围和分布、对治疗的反应、复发率和预后,在肌炎患者中差异很大。目前尚未建立肌炎患者ILD 管理的标准实践。
最近的研究表明,根据疾病行为和肌炎特异性自身抗体(MSA)特征,将肌炎相关性ILD 患者分层为更同质的组,从而改善预后并预防器官损伤的负担。本综述介绍了一种基于 2023 年 1 月之前通过 PubMed 检索相关文献的研究结果以及专家意见的肌炎相关性ILD 管理新范式。
正在制定肌炎相关性ILD 的管理策略,根据ILD 的严重程度以及疾病行为和 MSA 特征预测预后进行分层。开发精准医学治疗方法将使所有相关群体受益。