By América Torres
With the aim of providing you with information that may be useful in your medical practice, the Guide have summarized the main recommendations of the 2023 American College of Rheumatology Guideline for the Detection and Monitoring of Interstitial Lung Disease (ILD) in individuals with systemic autoimmune disease. Rheumatic disease.
This clinical guideline includes recommendations for the detection of Interstitial Lung Disease (ILD) in patients with Systemic Autoimmune Rheumatic Diseases (SARDs) [Rheumatoid Arthritis (RA), Systemic Sclerosis (SSc), Idiopathic Inflammatory Myositis (IIM, including polymyositis, dermatomyositis, antisynthetase syndrome, immune-mediated necrotizing myopathy), Mixed Connective Tissue Disease (MCTD), and Sjögren's Disease (SjD)] associated with the greatest risk of ILD, and for monitoring ILD progression. The Guide hope you find it helpful.
Recommendations for the detection of SARD-associated ILD
Recommendations for the detection of SARD-associated ILD
- For patients with SARDs at increased risk of developing Interstitial Lung Disease (ILD), the Guide conditionally recommends screening with PFTs (Pulmonary Function Tests).
- For patients with SARDs at increased risk of developing ILD, the Guide conditionally recommends screening with High-resolution computed tomography (HRCT) of the chest.
- For patients with SARDs at increased risk of developing ILD, the Guide conditionally recommends screening with HRCT chest and PFTs over PFTs alone.
- For patients with SARDs at increased risk of developing ILD, the Guide conditionally recommends against screening with 6-minute walking distance (6 MWD).
- For patients with SARDs at increased risk of developing ILD, the Guide conditionally recommends against screening with chest radiography.
- For patients with SARDs at increased risk of developing ILD, the Guide conditionally recommends against screening with ambulatory desaturation testing.
- For patients with SARDs at increased risk of developing ILD, the Guide conditionally recommends against screening with bronchoscopy.
- For patients with SARDs at increased risk of developing ILD, the Guide strongly recommends against screening with surgical lung biopsy.
Recommendations for Monitoring the Progression of Interstitial Lung Disease
Recommendations for Monitoring the Progression of Interstitial Lung Disease
- For patients with SARDs-ILD, the Guide conditionally recommends monitoring with PFTs.
- For patients with SARDs-ILD, the Guide conditionally recommends monitoring with HRCT chest.
- For patients with SARDs-ILD, the Guide conditionally recommends monitoring with PFTs and HRCT chest over PFTs alone.
- For patients with SARDs-ILD, the Guide conditionally recommends monitoring with ambulatory desaturation testing.
- For patients with SARDs-ILD, the Guide conditionally recommends against monitoring with chest radiography.
- For patients with SARDs-ILD, the Guide conditionally recommends against monitoring with 6MWD.
- For patients with SARDs-ILD, the Guide conditionally recommends against monitoring with bronchoscopy.
- For patients with IIM-ILD and SSc-ILD, the Guide suggest PFTs for monitoring every 3-6 months rather than either shorter or longer intervals, for the first year, then less frequently once stable.
- For patients with RA-ILD, SjD-ILD, and MCTD-ILD, the Guide suggest PFTs for monitoring every 3-12 months rather than shorter or longer intervals, for the first year, then less frequently once stable.
- For patients with SARDs-ILD, the Guide do not provide guidance about frequency of routine HRCT chest for monitoring ILD but suggest HRCT when clinically indicated.
- For patients with SARDs-ILD, the Guide suggest assessment for ambulatory desaturation every 3-12 months rather than at shorter or longer intervals.
Conclusion
In summary, the 2023 American College of Rheumatology Guidelines for the Detection and Monitoring of Interstitial Lung Disease in individuals with systemic autoimmune disease and rheumatic disease conditionally recommends the following screening tests:
• Pulmonary Function Tests: spirometry, lung volume, and diffusion capacity.
• High-resolution computed tomography of the chest.
Likewise, this document conditionally recommends these Pulmonary Function Tests: spirometry, lung volumes, and diffusion capacity in the following cases:
• For idiopathic inflammatory myopathy (IIM): every 3-6 months in the first year. Then less frequently, once the patient is stable.
• For systemic sclerosis: every 3-6 months in the first year. Then less frequently once the patient is stable.
• For rheumatoid arthritis, Sjögren's syndrome, mixed connective tissue disease: every 3-12 months in the first year. Then less frequently once the patient is stable.
It also conditionally recommends ambulatory desaturation testing every 3-12 months (this test can be performed during routine visits or as part of the 6-minute walking distance test). Chest computed tomography is conditionally recommended as needed.
Accurate and reliable tests
Accurate and reliable tests
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REFERENCE
2023 American College of Rheumatology (ACR) Guideline for the Screening and Monitoring of Interstitial Lung Disease in People with Systemic Autoimmune
Rheumatic Disease. https://assets.contentstack.io/v3/assets/bltee37abb6b278ab2c/blt7e2cadfc7bc986fb/interstitial-lung-disease-guideline-summary-screening-monitoring-2023.pdf
