Multidisciplinary Evaluation of Interstitial Lung Diseases: New Opportunities Linked to Rheumatologist Involvement

Autor: Giacomo Sgalla, S. L. Bosello, Lucrezia Verardi, Giuseppe Cicchetti, Bruno Iovene, Enrico De Lorenzis, Luca Richeldi, Francesco Varone, Lucio Calandriello, Anna Rita Larici, L. Gigante, Elisa Gremese, Gerlando Natalello
Rok vydání: 2020
Předmět:
musculoskeletal diseases
rheumatoid arthritis
medicine.medical_specialty
interstitial pneumonia with autoimmune features
Clinical Biochemistry
Article
03 medical and health sciences
0302 clinical medicine
immune system diseases
Internal medicine
medicine
030212 general & internal medicine
Family history
skin and connective tissue diseases
multidisciplinary team
Pulmonologists
Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA
interstitial lung disease
lcsh:R5-920
Lung
business.industry
systemic rheumatic autoimmune disease
Gold standard
Interstitial lung disease
Pulmonologist
respiratory system
medicine.disease
Connective tissue disease
respiratory tract diseases
medicine.anatomical_structure
030228 respiratory system
connective tissue disease
Rheumatoid arthritis
lcsh:Medicine (General)
business
Zdroj: Diagnostics
Volume 10
Issue 9
Diagnostics, Vol 10, Iss 664, p 664 (2020)
ISSN: 2075-4418
Popis: Multidisciplinary team (MDT) discussion is the gold standard in the management of interstitial lung disease (ILD). The rheumatologist is not routinely involved in MDT, even if up to 20% of ILD are related to systemic autoimmune rheumatic diseases (SARD). The study aims to assess the agreement and its variation over time between rheumatologists and pulmonologists in the screening of SARD and between rheumatologists and an MDT extended to rheumatologists (eMDT) in evaluating the progression of SARD. We computed the agreement between the pulmonologist and rheumatologist in the identification of red flags for SARDs of 81 ILD cases and between the rheumatologist alone and eMDT in the confirmation of 70 suspected SARD-ILD progressions. The agreement between rheumatologists and pulmonologists was moderate for the detection of autoimmunity test positivity (&kappa
= 0.475, p <
0.001) and family history of SARD (&kappa
= 0.491, p <
0.001) and fair for the identification of extrapulmonary symptoms (&kappa
= 0.225, p = 0.064) or routine laboratory abnormalities consistent with SARD. The average agreement between the rheumatologist and eMDT in the identification of ILD progression was moderate (&kappa
= 0.436, p <
0.001). The class of agreement improved from the first to the third semester. The average agreement with the rheumatologist ranged from fair to moderate, suggesting that a shared evaluation of SARD-ILD in eMDT could improve the diagnostic work-up and the evaluation of ILD progression.
Databáze: OpenAIRE
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