University of Toronto, Schroeder Arthritis Institute, Toronto Western Hospital, Mount Sinai Hospital, Toronto, Ontario, Canada.
Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York City.
Arthritis Care Res (Hoboken). 2024 Aug;76(8):1070-1082. doi: 10.1002/acr.25347. Epub 2024 Jul 8.
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.
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.
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.
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.
我们提供了针对系统性自身免疫性风湿病（SARD）患者间质性肺病（ILD）筛查和ILD 进展监测的循证建议，具体疾病包括类风湿关节炎、系统性硬化症、特发性炎性肌病、混合性结缔组织病和干燥综合征。
我们针对 SARD 患者ILD 筛查和监测，制定了与临床相关的人群、干预、比较和结局问题。进行了系统的文献回顾，并使用推荐评估、制定与评价分级方法对现有证据进行了评估。跨学科临床医生专家和患者投票小组就每个建议的方向和强度达成了共识。
制定了 15 条建议。对于这些有ILD 风险的 SARD 患者，我们有条件地推荐进行肺功能检查（PFTs）和胸部高分辨率计算机断层扫描（HRCT 胸部）；有条件地不推荐使用 6 分钟步行试验距离（6MWD）、胸部 X 线摄影、运动性低氧血症检测或支气管镜检查进行筛查；强烈不推荐使用外科肺活检进行筛查。我们有条件地推荐使用 PFTs、HRCT 胸部和运动性低氧血症检测监测ILD，有条件地不推荐使用 6MWD、胸部 X 线摄影或支气管镜检查监测ILD。我们提供了关于ILD 危险因素的指导和关于检测频率的建议，以评估 SARD 患者ILD 的发生。
本临床实践指南提出了美国风湿病学会和美国胸科医师学会首次针对 SARD 患者ILD 筛查和监测的建议。
