目的:我们提供了关于系统性自身免疫性风湿性疾病(SARDs)患者间质性肺病(ILD)筛查和ILD进展监测的循证建议。特别是类风湿性关节炎,系统性硬化症,特发性炎性肌病,混合性结缔组织病,和Sjögren病。
方法:我们开发了临床相关人群,干预,比较器,与SARDs患者ILD筛查和监测相关的结果问题。进行了系统的文献综述,现有证据使用建议分级进行评级,评估,发展,和评价方法。跨学科临床医生专家和患者的投票小组就每个建议的方向和强度达成了共识。
结果:提出了15项建议。为了筛查有ILD风险的SARD患者,我们有条件地推荐肺功能测试(PFTs)和胸部高分辨率计算机断层扫描(HRCT胸部);有条件地推荐不进行6分钟步行测试距离(6MWD)的筛查,胸部X线摄影术,动态去饱和试验,或支气管镜检查;强烈建议不要用外科肺活检进行筛查。我们有条件地建议使用PFT监控ILD,HRCT胸部,和动态去饱和测试,并有条件地建议不要使用6MWD进行监测,胸部X线摄影术,或支气管镜检查。我们提供有关ILD危险因素的指导以及有关测试频率的建议,以评估SARD患者ILD的发展。
结论:本临床实践指南提出了美国风湿病学会和美国胸科医师学会认可的关于SARDs患者ILD筛查和监测的首批建议。
OBJECTIVE: We provide evidence-based recommendations regarding screening for interstitial lung disease (ILD) and the monitoring for ILD progression in people with systemic autoimmune rheumatic diseases (SARDs), specifically rheumatoid arthritis, systemic sclerosis, idiopathic inflammatory myopathies, mixed connective tissue disease, and Sjögren disease.
METHODS: We developed clinically relevant population, intervention, comparator, and outcomes questions related to screening and monitoring for ILD in patients with SARDs. A systematic literature review was performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology. A Voting Panel of interdisciplinary clinician experts and patients achieved
consensus on the direction and strength of each recommendation.
RESULTS: Fifteen recommendations were developed. For screening people with these SARDs at risk for ILD, we conditionally recommend pulmonary function tests (PFTs) and high-resolution computed tomography of the chest (HRCT chest); conditionally recommend against screening with 6-minute walk test distance (6MWD), chest radiography, ambulatory desaturation testing, or bronchoscopy; and strongly recommend against screening with surgical lung biopsy. We conditionally recommend monitoring ILD with PFTs, HRCT chest, and ambulatory desaturation testing and conditionally recommend against monitoring with 6MWD, chest radiography, or bronchoscopy. We provide guidance on ILD risk factors and suggestions on frequency of testing to evaluate for the development of ILD in people with SARDs.
CONCLUSIONS: This clinical practice
guideline presents the first recommendations endorsed by the American College of Rheumatology and American College of Chest Physicians for the screening and monitoring of ILD in people with SARDs.