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Diagnosing lung involvement in inflammatory rheumatic diseases-Where do we currently stand?
Tobias Hoffmann1, Peter Oelzner1, Ulf Teichgräber2
1Department of Internal Medicine III, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany.
Frontiers in Medicine
|January 30, 2023
Summary
Early detection of interstitial lung disease (ILD) in inflammatory rheumatic disease (IRD) is crucial. This review details methods like pulmonary function tests (PFTs) and HRCT for diagnosing and monitoring IRD-ILD.
Area of Science:
- Rheumatology
- Pulmonology
- Radiology
Background:
- Lung involvement, primarily interstitial lung disease (ILD), is a frequent and severe complication in patients with inflammatory rheumatic diseases (IRD).
- IRD-ILD manifestations range from asymptomatic findings to severe respiratory failure, underscoring the need for early detection and monitoring.
Purpose of the Study:
- To provide a comprehensive overview of diagnostic and monitoring methods for ILD in IRD patients.
- To discuss the advantages and disadvantages of each method in routine clinical practice.
Main Methods:
- Review of standard screening and monitoring tools including pulmonary function tests (PFTs) like diffusing capacity of the lungs for carbon monoxide (DLCO) and forced vital capacity (FVC).
- Evaluation of high-resolution computed tomography (HRCT) for its high diagnostic accuracy.
- Discussion of advanced imaging like magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) for morphological and functional assessment.
- Consideration of emerging biomarkers (KL-6, CCL2, MUC5B) for detection and prognosis.
- Inclusion of invasive methods such as bronchoalveolar lavage (BAL) and lung biopsy, noting their current clinical relevance and unclear prognostic impact.
Main Results:
- HRCT is highly accurate for ILD diagnosis in IRD patients.
- PFTs (DLCO, FVC) are standard for screening and monitoring.
- MRI and PET/CT offer combined morphological and functional lung assessment.
- Biomarkers show potential for ILD detection and prognosis.
- Invasive methods like BAL and lung biopsy remain important despite unclear prognostic value.
Conclusions:
- A multimodal approach combining PFTs, HRCT, and potentially advanced imaging and biomarkers is essential for effective ILD management in IRD patients.
- The role of invasive procedures requires further clarification regarding their therapeutic and prognostic significance.
Keywords:
PET/CTbronchoalveolar lavage (BAL)high-resolution computed tomography (HRCT)inflammatory rheumatic diseaseinterstitial lung diseasepulmonary function testsMore Related Videos
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