Background Interstitial lung disease (ILD) is a serious complication of rheumatoid arthritis (RA) and different systemic autoimmune diseases. A multidisciplinary management allows optimizing handling and can help reducing its high morbidity and mortality.
Objectives To describe the characteristics of a cohort of patients with rheumatic disease-associated ILD (RHEU-ILD) controlled in a specific multidisciplinary consultation Pulmonology-Rheumatology, and to evaluate the changes produced by a joint activity on the diagnosis and/or treatment.
Methods All patients treated in the multidisciplinary consultation RHEU-ILD from September-2012 to October-2013 were included in the analysis. We collected the following data: origin of the patients, age, sex, diagnosis, debut and duration of the EPID, antibody profile, HRCT pattern, results of pulmonary function tests (PFTs), walking test, bronchoscopy and/or surgical biopsy (when needed), previous and current treatments, and any diagnostic and/or therapeutic change resulting from this consultation. The package SPSS 17.0 was used for descriptive statistics, and quantitative variables were compared using the t-test for paired samples.
Results Fifty-four patients were reviewed, 75.9% female, with a mean age of 63.56±15.40 years. Most patients came referred from Rheumatology (74.1%), since the debut of the EPID was after the diagnosis of the rheumatic disease in 50% of cases (33% simultaneous, and only 13% prior). The non specific interstitial pneumonia was the most frequent ILD (51.9%), followed by the usual interstitial pneumonia (UIP, 33.3%). The mean duration of the ILD was 5.49±5.31 years. ILD was associated, in order, to Systemic Sclerosis (24.2%), RA (20.4%), Sjögren (16.7%) and Antisynthetase syndrome (13%). The antibodies more frequently found were the ANA (33.3%), followed by anti-Ro (31.5%), RF (29.6%) and anti-Scl70 (18.5%). As for the PFTs, up to 55.6% of the patients showed a normal pattern, and only 29.6% a restrictive pattern. 22.2% of the patients showed desaturation when performing the walking test. Bronchoscopy was performed in 29 patients, while transbronchial biopsy and surgical biopsy were needed in 22 and 5 patients, respectively. A combined approach led to 4 changes of diagnosis (2 of them after surgical biopsy) and 9 changes of therapy (16.7%). Corticosteroids were the most used treatment (44%), followed by methotrexate (18.5%), rituximab (14.8%) and mycophenolate (9.3%). At follow-up, no significant change was observed on HRCT (72.2%) and/or the PFTs (baseline FVC 92.27% vs. last FVC 88.73%; p<0.107).
Conclusions The existence of a multidisciplinary consultation Pulmonology-Rheumatology can be key in the final diagnosis and/or treatment of our patients with rheumatic disease-associated ILD. A joint effort could help improving the prognosis of these patients.
Disclosure of Interest None declared