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Inicio Revista Colombiana de Reumatología (English Edition) Sequential approach to interstitial lung disease: An autoimmune perspective
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Vol. 31. Issue S1.
Interstitial Lung Disease Associated with Autoimmune Diseases
Pages S94-S109 (April 2024)
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Vol. 31. Issue S1.
Interstitial Lung Disease Associated with Autoimmune Diseases
Pages S94-S109 (April 2024)
Review Article
Sequential approach to interstitial lung disease: An autoimmune perspective
Abordaje diagnóstico de la enfermedad pulmonar intersticial: una perspectiva autoinmune
Camila Borda Sampera,b,
Corresponding author
camiborda@gmail.com

Corresponding author.
, Néstor Fabián Correa-Gonzáleza,b, Carlos Andrés Celis Preciadoa,c, Santiago Bernal-Macíasa,b, Juan Sebastián Sierraa,c, Daniel G. Fernández-Ávilaa,b
a Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
b Rheumatology Unit, San Ignacio University Hospital, Bogota, Colombia
c Pulmonology Unit, San Ignacio University Hospital, Bogota, Colombia
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Special issue
This article is part of special issue:
Vol. 31. Issue S1

Interstitial Lung Disease Associated with Autoimmune Diseases

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Abstract

Interstitial lung disease occurs with high frequency as an initial or late manifestation of multiple rheumatic diseases, including systemic sclerosis, idiopathic inflammatory myopathies, rheumatoid arthritis, systemic lupus erythematosus, primary Sjögren's syndrome and antineutrophil cytoplasmic antibody-associated vasculitis. Thus, the rheumatologist must be clear about certain concepts of pneumology, including the evaluation of lung function tests, the approach to radiological patterns observed on high-resolution computed tomography of the chest, and concepts such as interstitial pneumonia with autoimmune features. In this article, we present our approach to patients with interstitial lung disease, in whom an autoimmune etiology is suspected. We propose a sequential diagnostic strategy, recognizing the importance of the multidisciplinary team and including the autoimmune perspective with emphasis on clinical and serological domains. Other diagnostic tools such as capillaroscopy and minor salivary gland biopsy are also considered. We also take a critical look at the latest guidelines for progressive pulmonary fibrosis, since it is essential that the rheumatologist understands these concepts that are vital in a multidisciplinary team.

Keywords:
Interstitial lung disease
Autoimmunity
Progressive pulmonary fibrosis
Rheumatology
Pneumology
Multidisciplinary team
Connective tissue disease
Resumen

La enfermedad pulmonar intersticial se presenta con alta frecuencia como manifestación inicial o tardía de múltiples enfermedades reumáticas, incluyendo esclerosis sistémica, miopatías inflamatorias idiopáticas, artritis reumatoide, lupus eritematoso sistémico, síndrome de Sjögren primario y vasculitis asociada a anticuerpos anticitoplasma del neutrófilo. El reumatólogo debe tener claros algunos conceptos de neumología, incluyendo la evaluación de las pruebas de función pulmonar y la aproximación a los patrones radiológicos observados en la tomografía computarizada de tórax de alta resolución, además de conceptos como la neumonía intersticial con características autoinmunes. En este artículo presentamos nuestra propuesta sobre el abordaje de pacientes con enfermedad pulmonar intersticial en los que se sospecha una etiología autoinmune. Proponemos una estrategia diagnóstica secuencial, la cual contempla la importancia del equipo multidisciplinario e incluye la perspectiva autoinmune con énfasis en los dominios clínicos y serológicos, con otras herramientas diagnósticas como la capilaroscopia y la biopsia de glándula salival menor. Adicionalmente, analizamos críticamente las últimas guías de fibrosis pulmonar progresiva, para una adecuada comprensión por parte del reumatólogo, a efectos de entender mejor estos conceptos, los cuales son vitales en el equipo multidisciplinario.

Palabras clave:
Enfermedad pulmonar intersticial
Autoinmunidad
Fibrosis pulmonar progresiva
Reumatología
Neumología
Equipo multidisciplinario
Enfermedad del tejido conectivo

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