A Comparative Study on Connective Tissue Diseases Related Interstitial Lung Diseases and Idiopathic Interstitial Pneumonias_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

BianDachen ¹ ,  XiaoYonglong ¹ , LiuBujun ² , CaiHourong ¹

1. Department of Respiratory Medicine, Nanjing Medical University Drum Tower Clinical Medical School, Nanjing, Jiangsu, 210008, China;
2. ;

Corresponding author：

XiaoYonglong, Email: yonglong11a@163.com

Keywords：

Connective tissue disease-associated interstitial lung disease; Idiopathic interstitial pneumonias; Clinical features; Comparative analysis; Treatment

DOI：

10.7507/1671-6205.2014063

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Objective To compare the clinical characteristics,high-resolution computed tomography (HRCT) manifestations,pulmonary function results,serum autoantibodies and treatment modality of connective tissue diseases related interstitial lung diseases (CTD-ILDs) and idiopathic interstitial pneumonias (ⅡPs). Methods Patients explicitly diagnosed with CTD-ILDs and ⅡPs were retrospectively selected from Nanjing Drum Tower Hospital between January 2004 and December 2012.The clinical features were abstracted,including age,gender,symptoms,signs,serum autoantibody results,HRCT findings,and treatment.Patient characteristics were compared between CTD-ILDs and ⅡPs using a Pearson's χ² test for categorical variables,and a Student's t test for continuous variables. Results A total of 692 patients with complete data were included in this study,with 240 CTD-ILDs cases and 452 ⅡP cases.CTD-ILDs could exist in different types of CTDs,which were mainly shown in Sjogren's syndrome,rheumatoid arthritis,and dermatomyositis/polymyositis.Age,gender,connective tissue diseases related characteristics such as dry eyes,dry mouth,and arthralgia,and several autoantibodies such as ANA,SSA,SSB all showed significantly difference between CTD-ILDs and ⅡPs (P<0.05).However there were no significant differences in cough,dyspnea after exertion,velcro crackles on auscultation,or finger clubbing between two groups (P>0.05). The HRCT manifestations of CTD-ILDs were reticular opacities,patchy consolidation,band-like shadows,and pleural thickening.Pulmonary function tests commonly showed restrictive lung function and decreased diffusing capacity.The histopathologic findings of lung biopsies of CTD-ILDs were mostly chronic inflammatory cell infiltration,as well as hyperplasia of fibrous tissue and septal thickness.The finding of chronic inflammatory cell infiltration showed significant difference between CTD-ILDs and ⅡPs (P<0.05),while the HRCT manifestations,pulmonary function results or other histopathologic findings did not(P>0.05).The current treatment modality was corticosteroids plus immunosuppressants. Conclusion Despite the similarities,CTD-ILDs show distinct clinical,laboratory and imaging features from from ⅡPs in clinical practice.

Citation： BianDachen, XiaoYonglong, LiuBujun, CaiHourong. A Comparative Study on Connective Tissue Diseases Related Interstitial Lung Diseases and Idiopathic Interstitial Pneumonias. Chinese Journal of Respiratory and Critical Care Medicine, 2014, 13(3): 263-267. doi: 10.7507/1671-6205.2014063 Copy

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6.	Kocheril SV,Appleton BE,Somers EC,et al.Comparison of disease progression and mortality of connective tissue disease-related interstitial lung disease and idiopathic interstitial pneumonia.Arthritis Rheum,2005,53:549-557.
7.	Cottin V,Cordier JF.Combined pulmonary fibrosis and emphysema in connective tissue disease.Curr Opin Pulm Med,2012,18:418-427.
8.	Marie I,Hachulla E,Chérin P,et al.Interstitial lung disease in polymyositis and dermatomyositis.Arthritis Rheum,2002,47:614-622.
9.	Parambil JG,Myers JL,Lindell RM,et al.Interstitial lung disease in primary Sjogren syndrome.Chest,2006,130:1489-1495.
10.	Kim DS.Interstitial lung disease in rheumatoid arthritis:recent advances.Curr Opin Pulm Med,2006,12:346-353.
11.	Gross J,Hunninghake W.Idiopathic pulmonary fibrosis.N Engl J Med,2001,345:517-525.
12.	Nicholson AG,Colby TV,Wells AU.Histopathological approach to patterns of interstitial pneumonia in patient with connective tissue disorders.Sarcoidusis Vase Diffuse Lung Dis,2002,19:10-17.
13.	Homma Y,Ohtsuka Y,Tanimura K,et al.Can interstitial pneumonia as the sole presentation of collagen vascular diseases be differentiated from idiopathicinterstitial pneumonia? Respiration,1995,62:248-251.
14.	Fischer A,West SG,Swigris JJ,et al.Connective tissue disease-associated interstitial lung disease.Chest,2010,138:251-256.
15.	Antoniou KM,Margaritopoulos G,Economidou F,et al.Pivotal clinical dilemmas in collagen vascular diseases associated with interstitial lung involvement.Eur Respir J,2009,33:882-896.

1. Song JW,Do KH,Kim MY,et al.Pathologic and radiologic differences between idiopathic and collagen vascular disease-related usual interstitial pneumonia.Chest,2009,136:23-30.
2. American Thoracic Society,European Respiratory Society.American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classificationof the Idiopathic Interstitial Pneumonias.This joint statement of the American Thoracic Society (ATS),and the European Respiratory Society (ERS) was adopted by the ATS board of directors,June 2001 and by the ERS Executive Committee,June 2001.Am J Respir Crit Care Med,2002,165:277-304.
3. 中华医学会呼吸病学分会.特发性肺(间质)纤维化诊断和治疗指南(草案).中华结核和呼吸杂志,2002,25:387-389.
4. 李燕,苗立云,姜涵毅,等.特发性肺纤维化预后相关因素的回顾性研究.中国呼吸与危重监护杂志,2012,11:257-261.
5. Travis WD,Hunninghake G,King TE Jr,et al.Idiopathic nonspecific interstitial pne-umonia:report of an American Thoracic Society project.Am J Respir Crit CareMed,2008,177:1338-1347.
6. Kocheril SV,Appleton BE,Somers EC,et al.Comparison of disease progression and mortality of connective tissue disease-related interstitial lung disease and idiopathic interstitial pneumonia.Arthritis Rheum,2005,53:549-557.
7. Cottin V,Cordier JF.Combined pulmonary fibrosis and emphysema in connective tissue disease.Curr Opin Pulm Med,2012,18:418-427.
8. Marie I,Hachulla E,Chérin P,et al.Interstitial lung disease in polymyositis and dermatomyositis.Arthritis Rheum,2002,47:614-622.
9. Parambil JG,Myers JL,Lindell RM,et al.Interstitial lung disease in primary Sjogren syndrome.Chest,2006,130:1489-1495.
10. Kim DS.Interstitial lung disease in rheumatoid arthritis:recent advances.Curr Opin Pulm Med,2006,12:346-353.
11. Gross J,Hunninghake W.Idiopathic pulmonary fibrosis.N Engl J Med,2001,345:517-525.
12. Nicholson AG,Colby TV,Wells AU.Histopathological approach to patterns of interstitial pneumonia in patient with connective tissue disorders.Sarcoidusis Vase Diffuse Lung Dis,2002,19:10-17.
13. Homma Y,Ohtsuka Y,Tanimura K,et al.Can interstitial pneumonia as the sole presentation of collagen vascular diseases be differentiated from idiopathicinterstitial pneumonia? Respiration,1995,62:248-251.
14. Fischer A,West SG,Swigris JJ,et al.Connective tissue disease-associated interstitial lung disease.Chest,2010,138:251-256.
15. Antoniou KM,Margaritopoulos G,Economidou F,et al.Pivotal clinical dilemmas in collagen vascular diseases associated with interstitial lung involvement.Eur Respir J,2009,33:882-896.

Chinese Journal of Respiratory and Critical Care Medicine

A Comparative Study on Connective Tissue Diseases Related Interstitial Lung Diseases and Idiopathic Interstitial Pneumonias

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