Yair Levi1,2, Lilach Israeli-Shani1,2, Michael Kuchuk1,2, Gali Epstein Shochet1,2, Matthew Koslow1,2, David Shitrit3,4. 1. From the Internal Medicine Department E and Pulmonary Department, Meir Medical Center, Kfar Saba; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Internal Medicine Department A, Hillel Yaffe Medical Center, Hadera, Israel; Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA. 2. Y. Levi, MD, Internal Medicine Department E, Meir Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; L. Israeli-Shani, MD, Pulmonary Department, Meir Medical Center; M. Kuchuk, MD, Internal Medicine Department A, Hillel Yaffe Medical Center; G. Epstein Shochet, PhD, Pulmonary Department, Meir Medical Center; M. Koslow, MD, Pulmonary and Critical Care Medicine, Mayo Clinic; D. Shitrit, MD, Pulmonary Department, Meir Medical Center, and Sackler Faculty of Medicine, Tel Aviv University. Y. Levi and L. Israeli-Shani contributed equally to this study. 3. From the Internal Medicine Department E and Pulmonary Department, Meir Medical Center, Kfar Saba; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Internal Medicine Department A, Hillel Yaffe Medical Center, Hadera, Israel; Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA. davids3@clalit.org.il. 4. Y. Levi, MD, Internal Medicine Department E, Meir Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; L. Israeli-Shani, MD, Pulmonary Department, Meir Medical Center; M. Kuchuk, MD, Internal Medicine Department A, Hillel Yaffe Medical Center; G. Epstein Shochet, PhD, Pulmonary Department, Meir Medical Center; M. Koslow, MD, Pulmonary and Critical Care Medicine, Mayo Clinic; D. Shitrit, MD, Pulmonary Department, Meir Medical Center, and Sackler Faculty of Medicine, Tel Aviv University. Y. Levi and L. Israeli-Shani contributed equally to this study. davids3@clalit.org.il.
Abstract
OBJECTIVE: Interstitial lung diseases (ILD) form a diverse group of parenchymal lung disorders. Currently, a multidisciplinary team (MDT) including pulmonologists, radiologists, and pathologists is the gold standard for ILD diagnosis. Recently, additional subtypes of connective tissue disease (CTD)-ILD with autoimmune features were defined, making the rheumatological assessment increasingly important. We aimed to assess the effect of adding a rheumatologist to the MDT for routine rheumatology assessment. METHODS: A prospective study that assessed newly diagnosed ILD patients by 2 parallel blinded arms; all patients were evaluated by both MDT (e.g., history, physical examination, blood tests, pulmonary function tests, and biopsies, if needed) and a rheumatologist (e.g., history, physical examination, blood and serological tests). RESULTS: Sixty patients were assessed with the mean age of 67.3 ± 12 years, 55% male, and 28% smokers. The rheumatological assessment reclassified 21% of the idiopathic pulmonary fibrosis as CTD. Moreover, the number of CTD-ILD with autoimmune features was increased by 77%. These included antineutrophil cytoplasmic antibody-associated vasculitis, antisynthetase syndrome, and IgG4-related ILD. Retrospectively, rheumatological evaluation could have saved 7 bronchoscopies and 1 surgical biopsy. CONCLUSION: Adding routine rheumatology assessments could significantly increase diagnostic accuracy and reduce invasive procedures.
OBJECTIVE:Interstitial lung diseases (ILD) form a diverse group of parenchymal lung disorders. Currently, a multidisciplinary team (MDT) including pulmonologists, radiologists, and pathologists is the gold standard for ILD diagnosis. Recently, additional subtypes of connective tissue disease (CTD)-ILD with autoimmune features were defined, making the rheumatological assessment increasingly important. We aimed to assess the effect of adding a rheumatologist to the MDT for routine rheumatology assessment. METHODS: A prospective study that assessed newly diagnosed ILD patients by 2 parallel blinded arms; all patients were evaluated by both MDT (e.g., history, physical examination, blood tests, pulmonary function tests, and biopsies, if needed) and a rheumatologist (e.g., history, physical examination, blood and serological tests). RESULTS: Sixty patients were assessed with the mean age of 67.3 ± 12 years, 55% male, and 28% smokers. The rheumatological assessment reclassified 21% of the idiopathic pulmonary fibrosis as CTD. Moreover, the number of CTD-ILD with autoimmune features was increased by 77%. These included antineutrophil cytoplasmic antibody-associated vasculitis, antisynthetase syndrome, and IgG4-related ILD. Retrospectively, rheumatological evaluation could have saved 7 bronchoscopies and 1 surgical biopsy. CONCLUSION: Adding routine rheumatology assessments could significantly increase diagnostic accuracy and reduce invasive procedures.
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