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):1051-1069. doi: 10.1002/acr.25348. Epub 2024 Jul 8.
We provide evidence-based recommendations regarding the treatment of interstitial lung disease (ILD) in adults with systemic autoimmune rheumatic diseases (SARDs).
We developed clinically relevant population, intervention, comparator, and outcomes questions. A systematic literature review was then performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology. A panel of clinicians and patients reached consensus on the direction and strength of the recommendations.
Thirty-five recommendations were generated (including two strong recommendations) for first-line SARD-ILD treatment, treatment of SARD-ILD progression despite first-line ILD therapy, and treatment of rapidly progressive ILD. The strong recommendations were against using glucocorticoids in systemic sclerosis-ILD as a first-line ILD therapy and after ILD progression. Otherwise, glucocorticoids are conditionally recommended for first-line ILD treatment in all other SARDs.
This clinical practice guideline presents the first recommendations endorsed by the American College of Rheumatology and American College of Chest Physicians for the treatment of ILD in people with SARDs.
为患有系统性自身免疫性风湿病 (SARD) 的成人提供治疗间质性肺病 (ILD) 的循证建议。
我们制定了具有临床相关性的人群、干预、对照和结局问题。然后进行了系统的文献综述，并使用推荐评估、制定与评价分级法对现有证据进行了评估。一组临床医生和患者就建议的方向和力度达成了共识。
针对 SARD-ILD 的一线治疗、尽管进行一线ILD 治疗但仍出现 SARD-ILD 进展的治疗，以及快速进展性ILD 的治疗，共生成了 35 项建议（包括 2 项强推荐）。强推荐不建议将糖皮质激素作为系统性硬化症-ILD 的一线ILD 治疗药物，也不建议在ILD 进展后使用。否则，糖皮质激素被有条件推荐用于所有其他 SARD 的一线ILD 治疗。
本临床实践指南提出了美国风湿病学会和美国胸科学会为治疗 SARD 患者ILD 而首次认可的建议。
