Rheumatologists have an important role in the management of interstitial lung disease (ILD): a cross-speciality, multi-centre, UK perspective.
Rheumatologists have an important role in the management of interstitial lung disease (ILD): a cross-speciality, multi-centre, UK perspective.
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风湿病学家在间质性肺疾病 (ILD) 的治疗中发挥着重要作用：从英国的跨专业、多中心角度来看。
DOI：
10.1093/rheumatology/keac061
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Mehta P
中科院分区：
文献类型：
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作者：
Mehta P
间质性肺疾病（ILD）是指一组异质性且具有挑战性的弥漫性肺实质疾病。 ILD，包括进行性纤维化 ILD，是全身性自身免疫性 CTD 的常见表现，也是许多风湿性疾病死亡的主要原因 [1]。 ILD 在 SSc、特发性炎症性肌病和 RA 中最常见，但也可能出现在 SS 和 SLE 患者中。具有自身免疫特征的间质性肺炎这一研究术语于 2015 年定义，用于对可能表现出 CTD 临床、放射学或血清学特征但不符合正式 CTD 定义的 ILD 患者进行分类 [2]。然而，这些分类标准的价值和预后相关性目前尚不清楚，可能反映了我们当前风湿病 CTD 标准的局限性，并表明在 ILD 临床实践和研究中风湿病学家和呼吸科医生之间跨专业合作的需求日益增长。呼吸学会指南 [3, 4] 和英国 NHS 委托服务机构 [5] 推荐采用多学科团队 (MDT) 方法来诊断和管理 ILD，包括临床（包括呼吸和风湿病学输入）、放射学和（有指征时）组织病理学参与。近年来，管理 SSc-ILD 的策略取得了相当大的进步，这证明了跨专业合作的专注和协调一致；然而，其他自身免疫性 ILD 的进展缓慢。在这里，作为风湿病学家和呼吸科医生的集体，我们描述了风湿病学家在 ILD 治疗中的重要且不断扩大的作用（图 1），并概述了改善协作工作的策略，从而改善 ILD 患者的预后。尽管有所改善，但风湿病学家和呼吸科医生之间仍然非常需要建立更好的沟通和共享学习。共同决策的一个例子是 MTX 引起的 ILD 问题，这一问题现已被揭穿。尽管有足够的证据来缓解对纤维化 ILD 的担忧 [6]，但这两个领域的临床医生仍然保持沉默和不安。临床医生之间经常争论的其他争议领域包括使用 MTX 治疗并发 ILD 患者的关节疾病以及罕见但公认的 MTX 诱发的过敏性肺炎。这种混乱不仅限于 MTX。尽管人们认为 RA 中的肺部疾病普遍且重要，但人们对它知之甚少。
Interstitial lung disease (ILD) refers to a heterogeneous and challenging group of diffuse parenchymal lung disorders. ILD, including progressive fibrosing ILD, is a common manifestation of systemic autoimmune CTD and is a leading cause of mortality in many rheumatic conditions [1]. ILD is most frequent in SSc, idiopathic inflammatory myopathies and RA, but may also manifest in patients with SS and SLE. The research term interstitial pneumonia with autoimmune features was defined in 2015 to classify patients with ILD that may demonstrate clinical, radiological or serological characteristics of CTD, but do not meet formal CTD definitions [2]. However, the value and prognostic relevance of these classification criteria are currently unclear, may reflect limitations of our current rheumatological CTD criteria and demonstrate a growing need for cross-speciality collaboration between rheumatologists and respiratory physicians in ILD clinical practice and research. Respiratory Society guidelines [3, 4] and NHS England commissioning services [5] recommend a multidisciplinary team (MDT) approach to diagnosis and management of ILD, involving clinical (including respiratory and rheumatology input), radiological and (when indicated) histopathological involvement. Strategies for managing SSc-ILD have considerably advanced in recent years, a testament to dedicated and concerted cross-specialty collaboration; however, progress in other autoimmune ILDs has been slow. Here, as a collective of rheumatologists and respiratory physicians, we describe the important and expanding role of rheumatologists in the management of ILD (Fig. 1) and outline strategies to improve collaborative working and therefore outcomes in patients with ILD.Despite improvement, there remains considerable need to develop better communication and shared learning between rheumatologists and respiratory physicians. One example of shared decision-making is the now debunked issue of MTX-induced ILD. Despite a sufficient body of evidence to assuage concerns regarding fibrotic ILD [6], some reticence and unease remains among clinicians in both fields. Other areas of controversy and often debated among clinicians include the use of MTX for articular disease in patients with concurrent ILD and the rare, but recognized MTX-induced hypersensitivity pneumonitis. The confusion is not limited to MTX. Lung disease in RA is poorly understood, despite it being recognized as prevalent and important,