Lung lesions in connective tissue diseases
https://doi.org/10.18093/0869-0189-2019-29-5-604-611
Abstract
Frequency and clinical manifestations of respiratory disease in systemic connective tissue diseases (CTD) differ significantly including clinical course and outcomes. Pulmonary abnormalities are seen in 20% to 95% of patients with CTD ranging from subtle to life-threatening disease and could be fatal. Commonly, CTD-related interstitial lung disease (ILD) is crucial for prognosis. Interstitial pneumonias are the most frequent variant of respiratory disease in patients with CTD. CTD-related ILDs comprise 15% to 25% of all ILDs. Usually, respiratory disease develops in symptomatic CTD, but in some cases, ILD can be the first appearance of CTD which precedes systemic symptoms that could significantly impede early diagnosis. Therefore, diagnostic workup in ILD should consider extrapulmonary manifestations of CTD. Moreover, an intrinsic part of diagnostic algorithm should be specific laboratory assessment including measurement of autoantibodies. Combination of specific antibodies and clinical features provides higher probability of CTD diagnosis.
About the Authors
I. N. Trofimenko
Irkutsk State Medical Academy of Postgraduate Training – a branch of Russian Federal Academy of Continued Medical Education, Healthcare Ministry of Russia
Russian Federation
Russian Federation
Irina N. Trofimenko - Doctor of Medicine, Associate Professor, Department of Clinical Allergology and Pulmonology, Irkutsk State Medical Academy of Postgraduate Training – a branch of Russian Federal Academy of Continued Medical Education, Healthcare Ministry of Russia.
mkrn Yubileynyy 100, Irkutsk, 664079.
tel.: (9148) 77-80-96B. A. Chernyak
Irkutsk State Medical Academy of Postgraduate Training – a branch of Russian Federal Academy of Continued Medical Education, Healthcare Ministry of Russia
Russian Federation
Russian Federation
Boris A. Chernyak - Doctor of Medicine, Professor, Head of Department of Clinical Allergology and Pulmonology, Irkutsk State Medical Academy of Post-graduate Training – a branch of Russian Federal Academy of Continued Medical Education, Healthcare Ministry of Russia.
mkrn Yubileynyy 100, Irkutsk, 664079.
tel.: (9025) 68-78-70References
1. Jokerst C., Purdy H., Bhalla S. An overview of collagen vascular disease-associated interstitial lung disease. Semin. Roentgenol. 2015; 50 (1): 31–39. DOI: 10.1053/j.ro.2014.04.006.
2. Cottin V. Idiopathic interstitial pneumonias with connective tissue diseases features: a review. Respirology. 2016; 21 (2): 245–258. DOI: 10.1111/resp.12588.
3. Das S., Padhan P. An Overview of the extraarticular involvement in rheumatoid arthritis and its management. J. Pharmacol. Pharmacother. 2017; 8 (3): 81–86. DOI: 10.4103/jpp.JPP_194_16.
4. De Lauretis A., Veeraraghavan S., Renzoni E. Review series: Aspects of interstitial lung disease: connective tissue disease-associated interstitial lung disease: how does it differ from IPF? How should the clinical approach differ? Chron. Respir. Dis. 2011; 8 (1): 53–82. DOI: 10.1177/1479972310393758.
5. Spagnolo P., Cordier J.F., Cottin V. Connective tissue diseases, multimorbidity and the ageing lung. Eur. Respir. J. 2016; 47 (5): 1535–1558. DOI: 10.1183/13993003.00829-2015.
6. Vij R., Strek M.E. Diagnosis and treatment of connective tissue disease-associated interstitial lung disease. Chest. 2013; 143 (3): 814–824. DOI: 10.1378/chest.12-0741.
7. Jee A.S., Adelstein S., Bleasel J. et al. Role of autoantibodies in the diagnosis of connective-tissue disease ILD (CTD-ILD) and interstitial pneumonia with autoimmune features (IPAF). J. Clin. Med. 2017; 6 (5): pii: E51. DOI: 10.3390/jcm6050051.
8. Koo S.M., Uh S.T. Treatment of connective tissue disease-associated interstitial lung disease: the pulmonologist's point of view. Korean J. Intern. Med. 2017; 32 (4): 600–610. DOI: 10.3904/kjim.2016.212.
9. Wallis A., Spinks K. The diagnosis and management of interstitial lung diseases. Br. Med. J. 2015; 350: h2072. DOI: 10.1136/bmj.h2072.
10. Trofimenko I.N., Chernyak B.A. [Drug-induced interstitial lung diseases]. Meditsinskiy sovet. 2016; (5): 52–59. Available at: https://cyberleninka.ru/article/v/lekarstvenno-indutsirovannye-interstitsialnye-porazheniya-legkih-1 (in Russian).
11. Valeyre D., Duchemann B., Nunes H. et al. Interstitial lung diseases. Respiratory Epidemioloogy. ERS Monogr., chapter 6. 2014; 65: XIV–XVII.
12. Mathai S.C., Danoff S.K. Management of interstitial lung disease associated with connective tissue disease. Br. Med. J. 2016; 352: h6819. DOI: 10.1136/bmj.h6819.
13. Antoniou K.M., Margaritopoulos G., Economidou F. et al. Pivotal clinical dilemmas in collagen vascular diseases associated with interstitial lung involvement. Eur. Respir. J. 2009; 33 (4): 882–896. DOI: 10.1183/09031936.00152607.
14. Fischer A., du Bois R. Interstitial lung disease in connective tissue disorders. Lancet. 2012; 380 (9842): 689–698. DOI: 10.1016/S0140-6736(12)61079-4.
15. Tzelepis G.E., Toya S.P., Moutsopoulos H.M. Occult connective tissue diseases mimicking idiopathic interstitial pneumonias. Eur. Respir. J. 2008; 31 (1): 11–20. DOI: 10.1183/09031936.00060107.
16. Mittoo S., Gelber A.C., Christopher-Stine L. et al. Ascertainment of collagen vascular disease in patients presenting with interstitial lung disease. Respir. Med. 2009; 103 (8): 1152–1158. DOI: 10.1016/j.rmed.2009.02.009.
17. Duchemann B., Annesi-Maesano I., Jacobe de Naurois C. et al. Prevalence and incidence of interstitial lung diseases in a multi-ethnic county of Greater Paris. Eur. Respir. J. 2017; 50 (2): pii: 1602419. DOI: 10.1183/13993003.02419-2016.
18. Strange C., Highland K.B. Interstitial lung disease in the patient who has connective tissue disease. Clin. Chest Med. 2004; 25 (3): 549–559. DOI: 10.1016/j.ccm.2004.05.009.
19. Schneider F., Gruden J., Tazelaar H.D., Lislie K.O. Pleuropulmonary pathology in patients with rheumatic disease. Arch. Pathol. Lab. Med. 2012; 136 (10): 1242–1252. DOI: 10.5858/arpa.2012-0248-SA.
20. Kim E.J., Collard H.R., King T.E. Jr. Rheumatoid arthritis-associated interstitial lung disease: the relevance of histopathologic and radiographic pattern. Chest. 2009; 136 (5): 1397–1405. DOI: 10.1378/chest.09-0444.
21. Park J.H., Kim D.S., Park I.N. et al. Prognosis of fibrotic interstitial pneumonia: idiopathic versus collagen vascular disease-related subtypes. Am. J. Respir. Crit. Care Med. 2007; 175 (7): 705–711. DOI: 10.1164/rccm.200607-912OC.
22. Romagnoli M., Nannini C., Piciucchi S. et al. Idiopathic nonspecific interstitial pneumonia: an interstitial lung disease associated with autoimmune disorders? Eur. Respir. J. 2011; 38 (2): 384–391. DOI: 10.1183/09031936.00094910.
23. Karam M.B., Peivareh H., Mosadegh L. Thoracic imaging findings of collagen vascular diseases: a CT study. Tanaffos. 2014; 13 (1): 43–47.
24. Sato S., Hoshino K., Satoh T. et al. RNA helicase encoded by melanoma differentiation-associated gene 5 is a major autoantigen in patients with clinically amyopathic dermatomyositis: Association with rapidly progressive interstitial lung disease. Arthritis Rheum. 2009; 60 (7): 2193–2200. DOI: 10.1002/art.24621.
25. Gayraud M. Raynaud's phenomenon. Joint Bone Spine. 2007; 74 (1): e1–8. DOI: 10.1016/j.jbspin.2006.07.002.
26. Ungprasert P., Crowson C.S., Chowdhary V.R. et al. Epidemiology of mixed connective tissue disease, 1985–2014: a population-based study. Arthritis Care Res. (Hoboken). 2016; 68 (12): 1843–1848. DOI: 10.1002/acr.22872.
27. Gladman D.D. Overview of the clinical manifestations of systemic lupus erythematosus in adults. Available at: https://www.uptodate.com/contents/overview-of-the-clinical-manifestations-of-systemic-lupus-erythematosus-in-adults [Accessed: May 30, 2018].
28. Baer A.N. Clinical manifestations of Sjögren's syndrome: Extraglandular disease. Available at: https://www.uptodate.com/contents/clinical-manifestations-of-sjogrens-syndrome-extraglandular-disease [Accessed: May 30, 2018].
29. Miller M.L., Vleugels R.A. Clinical manifestations of dermatomyositis and polymyositis in adults. Available at: https://www.uptodate.com/contents/clinical-manifestations-of-dermatomyositis-and-polymyositis-in-adults [Accessed: May 30, 2018].
30. Lake F.R. Interstitial lung disease in rheumatoid arthritis. Available from: https://www.uptodate.com/contents/interstitial-lung-disease-in-rheumatoid-arthritis [Accessed: May 30, 2018].
31. King T.E. Approach to the adult with interstitial lung disease: Diagnostic testing Available at: https://www.uptodate.com/contents/approach-to-the-adult-with-interstitial-lung-disease-diagnostic-testing [Accessed: May 30, 2018].
32. Raghu G., Collard H.R., Egan J.J. et al. An off icial ATS/ERS/JRS/ALAT statement: Idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am. J. Respir. Crit. Care Med. 2011; 183 (6): 788–824. DOI: 10.1164/rccm.2009-040GL.
33. Solomon D.H., Kavanaugh A.J., Schur P.H. Evidence-based guidelines for the use of immunologic tests: antinuclear antibody testing. Arthritis Rheum. 2002; 47 (4): 434–444. DOI: 10.1002/art.10561.
34. Giles J.T., Danoff S.K., Sokolove J. et al. Association of fine specificity and repertoire expansion of anticitrullinated peptide antibodies with rheumatoid arthritis associated interstitial lung disease. Ann. Rheum. Dis. 2014; 73 (8): 1487–1494. DOI: 10.1136/annrheumdis-2012-203160.
35. Yin Y., Liang D., Zhao L. et al. Anti-cyclic citrullinated peptide antibody is associated with interstitial lung disease in patients with rheumatoid arthritis. PLoS One. 2014; 9 (4): e92449. DOI: 10.1371/journal.pone.0092449.
36. Fischer A., Antoniou K.M., Brown K.K. et al. An official European Respiratory Society/American Thoracic Society research statement: Interstitial pneumonia with autoimmune features. Eur. Respir. J. 2015; 46 (4): 976–987. DOI: 10.1183/13993003.00150-2015.
37. Tashkin D.P., Elashoff R., Clements P.J. et al. Cyclophosphamide versus placebo in scleroderma lung disease. N. Engl. J. Med. 2006; 354 (25): 2655–2666. DOI: 10.1056/NEJMoa055120.
38. Tashkin D.P., Roth M.D., Clements P.J. et al. Mycophenolate mofetil versus oral cyclophosphamide in scleroderma-related interstitial lung disease (SLS-II), a randomised controlled, double-blind, parallel group trial. Lancet Respir. Med. 2016; 4 (9): 708–719. DOI: 10.1016/S2213-2600(16)30152-7.
39. Saunders P., Tsipouri V., Keir G.J. et al. Rituximab versus cyclophosphamide for the treatment of connective tissue disease-associated interstitial lung disease (RECITAL): study protocol for a randomised controlled trial. Trials. 2017; 18 (1): 275. DOI: 10.1186/s13063-017-2016-2.
40. Huang H., Feng R.E., Li S. et al. A case report: The efficacy of pirfenidone in a Chinese patient with progressive systemic sclerosis-associated interstitial lung disease: A CARE-compliant article. Medicine (Baltimore). 2016; 95 (27): e4113. DOI: 10.1097/MD.0000000000004113.
41. Miura Y., Saito T., Fujita K. et al. Clinical experience with pirfenidone in five patients with scleroderma-related interstitial lung disease. Sarcoidosis Vasc. Diffuse Lung Dis. 2014; 31 (3): 235–238.
42. Duarte A.C., Santos M.J., Cordeiro A. Anti-fibrotic nintedanib – a new opportunity for systemic sclerosis patients? Clin. Rheumatol. 2018; 37 (4): 1123–1127. DOI: 10.1007/s10067-017-3867-3.
43. Distler O., Brown K.K., Distler J.H.W. et al. Design of a randomised, placebo-controlled clinical trial of nintedanib in patients with systemic sclerosis-associated interstitial lung disease (SENSCIS™). Clin. Exp. Rheumatol. 2017; 35, Suppl. 106 (4): 75–81.
Review
For citations:
Trofimenko I.N., Chernyak B.A. Lung lesions in connective tissue diseases. PULMONOLOGIYA. 2019;29(5):604-611. (In Russ.) https://doi.org/10.18093/0869-0189-2019-29-5-604-611
Views:
12644
Email this article 