Expert Opinion Guidance on the Detection of Early Connective Tissue Diseases in Interstitial Lung Disease

Rajaie Namas; Mohamed Elarabi; Fouad Fayad; Aqeel A Muhanna Ghanem; Adeeba Al-Herz; Waleed Hafiz; Abhay Joshi; Mira Merashli; Jad Okais; Imad Uthman; Khuloud Saleh Essa; Mohammed A Omair

doi:10.2147/OARRR.S401709

Expert Opinion Guidance on the Detection of Early Connective Tissue Diseases in Interstitial Lung Disease

Open Access Rheumatol. 2023 May 29:15:93-102. doi: 10.2147/OARRR.S401709. eCollection 2023.

Authors

Affiliations

¹ Department of Internal Medicine, Division of Rheumatology, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
² Rheumatology Department, Hotel-Dieu de France Hospital, Lebanon and Saint Joseph University of Beirut-Beirut (Lebanon), Beirut, Lebanon.
³ Rheumatology Unit, Mubarak Al Kabeer Hospital, Jabriya, Kuwait.
⁴ Department of Rheumatology, Amiri Hospital, Kuwait City, Kuwait.
⁵ Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
⁶ Department of Rheumatology, Burjeel Day Surgery, Abu Dhabi, United Arab Emirates.
⁷ Division of Rheumatology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
⁸ Rheumatology Unit, Farwaniya Hospital, Kuwait City, Kuwait.
⁹ Department of Medicine, King Saud University, Riyadh, Saudi.

Abstract

There is a significant variation in symptoms and clinical presentation of connective tissue disorders (CTD) associated with interstitial lung disease (ILD) (CTD-ILD). This presents difficulties in the diagnosis and treatment of CTD-ILD. Early detection and treatment of CTD-ILD using a multidisciplinary approach have been shown to enhance patient outcomes. This exercise aims to explore clinical components to develop a screening tool for pulmonologists for early detection of CTD in ILD and to provide a framework for a multidisciplinary approach in managing CTD-ILD. This in turn will lead to early treatment of CTD-ILD in collaboration with rheumatologists. A panel of 12 leading rheumatologists from the Middle East and North Africa (MENA) region met virtually to select the most relevant clinical findings to aid in identifying CTD-ILD. Twelve panellists opted to investigate seven of the most common inflammatory autoimmune disorders. The panel discussed how to improve the early detection of CTD-ILD. Clinical characteristics were categorized, and a nine-item questionnaire was created. A biphasic algorithm was developed to guide early referral to a rheumatologist based on the presence of one of nine clinical features of CTD (Phase 1) or the presence of CTD-specific antibodies (Phase 2). A brief questionnaire has been developed to serve as a simple and practical screening tool for CTD-ILD detection. Additional research is needed to validate and evaluate the tool in longitudinal cohorts.

Keywords: CTD-ILD; connective tissue disease-associated interstitial lung disease; multidisciplinary team; pulmonologists; rheumatologists; screening.