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

Abstract

Rajaie Namas,1 Mohamed Elarabi,1 Fouad Fayad,2 Aqeel A Muhanna Ghanem,3 Adeeba Al-Herz,4 Waleed Hafiz,5 Abhay Joshi,6 Mira Merashli,7 Jad Okais,2 Imad Uthman,7 Khuloud Saleh Essa,8 Mohammed A Omair9 1Department of Internal Medicine, Division of Rheumatology, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; 2Rheumatology Department, Hotel-Dieu de France Hospital, Lebanon and Saint Joseph University of Beirut-Beirut (Lebanon), Beirut, Lebanon; 3Rheumatology Unit, Mubarak Al Kabeer Hospital, Jabriya, Kuwait; 4Department of Rheumatology, Amiri Hospital, Kuwait City, Kuwait; 5Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; 6Department of Rheumatology, Burjeel Day Surgery, Abu Dhabi, United Arab Emirates; 7Division of Rheumatology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon; 8Rheumatology Unit, Farwaniya Hospital, Kuwait City, Kuwait; 9Department of Medicine, King Saud University, Riyadh, SaudiCorrespondence: Rajaie Namas, Division of Rheumatology, Department of Internal Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates, Tel [phone], Fax [phone], Email [email protected]; [email protected]: 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: connective tissue disease-associated interstitial lung disease, CTD-ILD, rheumatologists, pulmonologists, screening, multidisciplinary team

Keywords

• connective tissue disease-associated interstitial lung disease
• ctd-ild
• rheumatologists
• pulmonologists
• screening
• multidisciplinary team.