The American College of Rheumatology (ACR) announced the publication of new guidelines regarding the screening, monitoring, and treatment of interstitial lung disease in patients with systemic autoimmune rheumatic diseases. Experts noted that patients with rheumatoid arthritis, systemic sclerosis, and idiopathic inflammatory myopathies may be at greater risk of developing and dying from interstitial lung disease. “Increasing awareness of the groups at highest risk for developing [the disease] and implementing appropriate screening and treatment practices should have long-term benefits,” underscored guideline author Sonye K. Danoff, MD, PhD, Director of the Interstitial Lung Disease/Pulmonary Fibrosis program at the Johns Hopkins University School of Medicine.
Among the new recommendations were:
- High-resolution CT imaging of the chest or pulmonary function tests may benefit patients at high risk of interstitial lung disease development or progression
- Screening and monitoring with a 6-minute walk test distance, chest radiography, and bronchoscopy may not offer benefit
- Glucocorticoids may be administered as short-term, first-line treatment for interstitial lung disease in patients with systemic autoimmune rheumatic diseases—but should be avoided in those with systemic sclerosis to prevent scleroderma renal crisis
- Physicians may administer mycophenolate, rituximab, cyclophosphamide, and azathioprine as first-line treatment for patients with interstitial lung disease; but should avoid leflunomide, methotrexate, tumor necrosis factor (TNF) inhibitors, and abatacept.