2023 American College of Rheumatology (ACR)/American College of Chest Physicians (CHEST) Guideline for the Screening and Monitoring of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Diseases

Author:

Johnson Sindhu R.1ORCID,Bernstein Elana J.2ORCID,Bolster Marcy B.3ORCID,Chung Jonathan H.4,Danoff Sonye K.5,George Michael D.6ORCID,Khanna Dinesh7ORCID,Guyatt Gordon8,Mirza Reza D.8,Aggarwal Rohit9ORCID,Allen Aberdeen10,Assassi Shervin11ORCID,Buckley Lenore12ORCID,Chami Hassan A.5,Corwin Douglas S.13,Dellaripa Paul F.14ORCID,Domsic Robyn T.9ORCID,Doyle Tracy J.14,Falardeau Catherine Marie15,Frech Tracy M.16ORCID,Gibbons Fiona K.3,Hinchcliff Monique12ORCID,Johnson Cheilonda6,Kanne Jeffrey P.17,Kim John S.18,Lim Sian Yik19ORCID,Matson Scott20,McMahan Zsuzsanna H.5ORCID,Merck Samantha J.21,Nesbitt Kiana22,Scholand Mary Beth23,Shapiro Lee24,Sharkey Christine D.17,Summer Ross25,Varga John7,Warrier Anil26,Agarwal Sandeep K.27,Antin‐Ozerkis Danielle12,Bemiss Bradford28,Chowdhary Vaidehi12,Dematte D'Amico Jane E.28,Hallowell Robert3,Hinze Alicia M.29ORCID,Injean Patil A.30,Jiwrajka Nikhil6ORCID,Joerns Elena K.31ORCID,Lee Joyce S.32,Makol Ashima29,McDermott Gregory C.14ORCID,Natalini Jake G.33ORCID,Oldham Justin M.7,Saygin Didem9,Lakin Kimberly Showalter34,Singh Namrata35,Solomon Joshua J.36,Sparks Jeffrey A.14ORCID,Turgunbaev Marat37,Vaseer Samera38,Turner Amy37ORCID,Uhl Stacey39,Ivlev Ilya39ORCID

Affiliation:

1. University of Toronto, Schroeder Arthritis Institute, Toronto Western Hospital, Mount Sinai Hospital Toronto Ontario Canada

2. Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center New York City

3. Massachusetts General Hospital Boston

4. The University of Chicago Medicine Chicago Illinois

5. Johns Hopkins University School of Medicine Baltimore Maryland

6. University of Pennsylvania Philadelphia

7. University of Michigan Ann Arbor

8. McMaster University Hamilton Ontario Canada

9. University of Pittsburgh Pittsburgh Pennsylvania

10. Parlin New Jersey

11. University of Texas Health Science Center at Houston

12. Yale School of Medicine New Haven Connecticut

13. St. Luke's University Health Network Bethlehem Pennsylvania

14. Brigham and Women's Hospital Boston Massachusetts

15. Kissimmee Florida

16. Vanderbilt University Medical Center Nashville Tennessee

17. University of Wisconsin School of Medicine and Public Health Madison

18. University of Virginia School of Medicine Charlottesville

19. Hawaii Pacific Health Aiea

20. University of Kansas Medical Center Kansas City

21. Saint Francis Health System Tulsa Oklahoma

22. Lansdowne Pennsylvania

23. University of Utah Salt Lake City

24. Albany Medical College Albany New York

25. Thomas Jefferson University Hospital Philadelphia Pennsylvania

26. Millennium Physicians Huntsville Texas

27. Baylor College of Medicine Houston Texas

28. Northwestern University Chicago Illinois

29. Mayo Clinic Rochester Minnesota

30. Cedars‐Sinai Los Angeles California

31. UT Southwestern Medical Center Dallas Texas

32. University of Colorado Denver Aurora

33. New York University Langone Health New York City

34. Hospital for Special Surgery, Weill Cornell Medicine New York City

35. University of Washington Seattle

36. National Jewish Health Denver Colorado

37. American College of Rheumatology Atlanta Georgia

38. University of Oklahoma Oklahoma City

39. ECRI, Center for Clinical Evidence and Guidelines Plymouth Meeting Pennsylvania

Abstract

ObjectiveWe 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.MethodsWe 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.ResultsFifteen 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.ConclusionThis 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.

Publisher

Wiley

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