PMID- 31977850
OWN - NLM
STAT- MEDLINE
DCOM- 20200210
LR  - 20221005
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 99
IP  - 4
DP  - 2020 Jan
TI  - Impact of a systematic evaluation of connective tissue disease on diagnosis 
      approach in patients with interstitial lung diseases.
PG  - e18589
LID - 10.1097/MD.0000000000018589 [doi]
LID - e18589
AB  - To date, there is no clear agreement regarding which is the best method to detect 
      a connective tissue disease (CTD) during the initial diagnosis of interstitial 
      lung diseases (ILD). The aim of our study was to explore the impact of a 
      systematic diagnostic strategy to detect CTD-associated ILD (CTD-ILD) in clinical 
      practice, and to clarify the significance of interstitial pneumonia with 
      autoimmune features (IPAF) diagnosis in ILD patients.Consecutive patients 
      evaluated in an ILD Diagnostic Program were divided in 3 groups: IPAF, CTD-ILD, 
      and other ILD forms. Clinical characteristics, exhaustive serologic testing, high 
      resolution computed tomography (HRCT) images, lung biopsy specimens, and 
      follow-up were prospectively collected and analyzed.Among 139 patients with ILD, 
      CTD was present in 21 (15.1%), 24 (17.3%) fulfilled IPAF criteria, and 94 (67.6%) 
      were classified as other ILD forms. Specific systemic autoimmune symptoms such as 
      Raynaud phenomenon (19%), inflammatory arthropathy (66.7%), and skin 
      manifestations (38.1%) were more frequent in CTD-ILD patients than in the other 
      groups (all P < .001). Among autoantibodies, antinuclear antibody was the most 
      frequently found in IPAF (42%), and CTD-ILD (40%) (P = .04). Nonspecific 
      interstitial pneumonia, detected by HRCT scan, was the most frequently seen 
      pattern in patients with IPAF (63.5%), or CTD-ILD (57.1%) (P < .001). In 
      multivariate analysis, a suggestive radiological pattern by HRCT scan (odds ratio 
      [OR] 15.1, 95% confidence interval [CI] 4.7-48.3, P < .001) was the strongest 
      independent predictor of CTD-ILD or IPAF, followed by the presence of clinical 
      features (OR 14.6, 95% CI 4.3-49.5, P < .001), and serological features (OR 12.4, 
      95% CI 3.5-44.0, P < .001).This systematic diagnostic strategy was useful in 
      discriminating an underlying CTD in patients with ILD. The defined criteria for 
      IPAF are fulfilled by a considerable proportion of patients referred for ILD.
FAU - Hernandez-Gonzalez, Fernanda
AU  - Hernandez-Gonzalez F
AD  - Servei de Pneumologia, Hospital Clinic, IDIBAPS, Universitat de Barcelona.
FAU - Prieto-Gonzalez, Sergio
AU  - Prieto-Gonzalez S
AD  - Servei de Malalties Autoimmunes, Hospital Clinic.
FAU - Brito-Zeron, Pilar
AU  - Brito-Zeron P
AD  - Servei de Malalties Autoimmunes, Hospital Clinic.
FAU - Cuerpo, Sandra
AU  - Cuerpo S
AD  - Servei de Pneumologia, Hospital Clinic, IDIBAPS, Universitat de Barcelona.
FAU - Sanchez, Marcelo
AU  - Sanchez M
AD  - Servicio de Radiodiagnostico, Hospital Clinic.
FAU - Ramirez, Jose
AU  - Ramirez J
AD  - Servicio de Anatomia Patologica, Hospital Clinic.
FAU - Agusti, Carlos
AU  - Agusti C
AD  - Servei de Pneumologia, Hospital Clinic, IDIBAPS, Universitat de Barcelona.
FAU - Lucena, Carmen Maria
AU  - Lucena CM
AD  - Servei de Pneumologia, Hospital Clinic, IDIBAPS, Universitat de Barcelona.
FAU - Paradela, Marina
AU  - Paradela M
AD  - Servei de Cirurgia Toracica, Hospital Clinic, IDIBAPS, Universitat de Barcelona, 
      Barcelona.
FAU - Grafia, Ignacio
AU  - Grafia I
AD  - Servei de Malalties Autoimmunes, Hospital Clinic.
FAU - Espinosa, Gerard
AU  - Espinosa G
AD  - Servei de Malalties Autoimmunes, Hospital Clinic.
FAU - Sellares, Jacobo
AU  - Sellares J
AD  - Servei de Pneumologia, Hospital Clinic, IDIBAPS, Universitat de Barcelona.
AD  - Centro de Investigacion Biomedica En Red-Enfermedades Respiratorias (CibeRes, 
      CB06/06/0028), Barcelona, Spain.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Autoantibodies)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Autoantibodies/immunology
MH  - Biopsy
MH  - Connective Tissue Diseases/*complications/*diagnosis/pathology
MH  - Enzyme-Linked Immunosorbent Assay
MH  - Female
MH  - Humans
MH  - Lung Diseases, Interstitial/*complications/*diagnosis/pathology
MH  - Male
MH  - Middle Aged
MH  - Tomography, X-Ray Computed
PMC - PMC7004576
COIS- This work has been financed with the grant SLT008/18/00176 and the support of the 
      Department of Health of Generalitat de Catalunya, in the call for grants 
      2019-2021, under a competitive regime, for the financing of different programs 
      and instrumental actions included in the Strategic Research and Innovation Plan 
      in Health 2016-2020. It has also been financed by SEPAR, SOCAP, FUCAP and with 
      the PhD4MD Programme of the Institute for Research in Biomedicine (IRB) 
      Barcelona, Hospital Clinic of Barcelona and the Institut d'Investigacions 
      Biomediques August Pi i Sunyer (IDIBAPS). The authors have no conflicts of 
      interest to disclose.
EDAT- 2020/01/25 06:00
MHDA- 2020/02/11 06:00
PMCR- 2020/01/24
CRDT- 2020/01/25 06:00
PHST- 2020/01/25 06:00 [entrez]
PHST- 2020/01/25 06:00 [pubmed]
PHST- 2020/02/11 06:00 [medline]
PHST- 2020/01/24 00:00 [pmc-release]
AID - 00005792-202001240-00009 [pii]
AID - MD-D-19-07317 [pii]
AID - 10.1097/MD.0000000000018589 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2020 Jan;99(4):e18589. doi: 10.1097/MD.0000000000018589.