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Rheumatology (Oxford). 2011 Mar;50(3):489-93. doi: 10.1093/rheumatology/keq233. Epub 2010 Aug 4.

The impact of rheumatological evaluation in the management of patients with interstitial lung disease.

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  • 1Department of Medicine, Division of Rheumatology, Massachussetts General Hospital, 55 Fruit Street, Bulfinch-165, Boston, MA 02114, USA. fcastelino@partners.org

Abstract

OBJECTIVE:

We hypothesized that multi-disciplinary assessment of patients with interstitial lung disease (ILD) would lead to improved diagnosis and management.

METHODS:

Our multi-disciplinary ILD group evaluated 50 patients referred to our tertiary care practice over a 12-month period. Evaluation consisted of independent assessments by a pulmonologist and rheumatologist, including complete history and physical examination, review of laboratory data, as well as review of imaging and pathological specimens in conjunction with a radiologist and pathologist experienced in ILD. Therapy was initiated or changed in collaboration with the referring physicians.

RESULTS:

Mean age was 65 years for patients with rheumatic or CTD-related ILD (CTD-ILD) and 70 years for those with idiopathic pulmonary fibrosis (IPF). The final diagnosis after evaluation in the clinic was 25 patients with CTD-ILD, 15 patients with IPF and 10 patients with other forms of lung disease. Of the patients with a final diagnosis of CTD-ILD, 28% were referred with a diagnosis of IPF. Among those referred with CTD-ILD, 36% had their diagnosis changed to an alternate CTD-ILD. In total, the diagnosis was changed in 54% of patients who presented to the ILD clinic. Changes in therapy occurred in 80% of patients with CTD-ILD and in 27% of patients with IPF.

CONCLUSION:

A multi-disciplinary ILD clinic offers patients an innovative mode of health-care delivery that can enhance diagnosis, affect treatment regimens and improve quality of care. Rheumatologists play a significant role in the clinical care of these patients and should evaluate all patients with ILD.

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