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Directrices de práctica clínica ERS/EULAR para las enfermedades pulmonares intersticiales asociadas a las

Katerina M Antoniou^1,2, Oliver Distler^3,2, Ana-Maria Gheorghiu⁴

¹Department of Respiratory Medicine, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Greece.

The European respiratory journal

|September 4, 2025

Resumen

Las nuevas directrices estandarizan el cuidado de la enfermedad pulmonar intersticial (ILD) en pacientes con enfermedades del tejido conectivo (CTD). Estas recomendaciones basadas en la evidencia tienen como objetivo mejorar el diagnóstico, el tratamiento y el seguimiento para obtener mejores resultados para los pacientes.

Área de la Ciencia:

Pulmonología y Reumatología
Directrices para la práctica clínica
Enfermedades del tejido conectivo

Sus antecedentes:

La enfermedad pulmonar intersticial (ILD) es una complicación grave de las enfermedades del tejido conectivo (CTD).
La atención estandarizada es crucial para el manejo de CTD-ILD, dada su alta morbilidad y mortalidad.
Las directrices existentes carecían de enfoques estandarizados y completos para el CTD-ILD.

Objetivo del estudio:

Desarrollar directrices de práctica clínica basadas en la evidencia para el cribado, el diagnóstico, el tratamiento y el seguimiento de la DTC-DIC.
Estandarizar la atención al paciente en varias enfermedades del tejido conectivo asociadas con ILD.
Proporcionar orientación práctica para los médicos que manejan pacientes con DTC-DIL.

Principales métodos:

Se formó un grupo de trabajo conjunto de la Sociedad Respiratoria Europea y la Alianza Europea de Asociaciones de Reumatología.
Las recomendaciones se desarrollaron utilizando preguntas PICO y preguntas narrativas complementarias, con pruebas clasificadas por la metodología GRADE.
El marco de pruebas para la toma de decisiones sirvió de guía para la formulación de recomendaciones para el CTD-ILD.

Principales resultados:

Se establecieron recomendaciones para 25 PICO y 28 preguntas narrativas que cubren ILD en esclerosis sistémica, AR, miopatías, Sjögren, SLE y MCTD.
Las pruebas insuficientes impidieron las recomendaciones para el riesgo de progresión de ILD en MCTD, SjD, SLE, y para pirfenidona en no-RA CTD-ILD.
Se crearon algoritmos de detección, diagnóstico, monitoreo y tratamiento basados en las recomendaciones.

Conclusiones:

Las directrices ofrecen recomendaciones prácticas basadas en la evidencia para los médicos que manejan la DTC-DIC.
Se identificaron lagunas significativas en la evidencia, lo que pone de relieve la necesidad de realizar más investigaciones.
Las recomendaciones tienen como objetivo optimizar la atención al paciente y estandarizar el manejo de la DTC-DIC.

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