AB1135 THE MANAGEMENT OF INTERSTITIAL LUNG DISEASES: THE IMPORTANCE OF THE RHEUMATOLOGIC EXPERTISE IN MULTIDISCIPLINARY MEETINGS

Abstract

Background Multidisciplinary Team (MDT) meetings are the current “gold standard” in interstitial lung disease (ILD) diagnosis. Requisite participants are respiratory physicians, radiologists and pathologists. A rheumatologist physician is not routinary involved in MDT even if up to 20% of ILD are related to connective tissue disease, rheumatoid arthritis or systemic vasculitis. Objectives The aim of this study is to evaluate the prevalence and predictors of systemic rheumatological diseases in a cohort of patients with ILD, evaluated by a rheumatology specialist on the advice of MDT in a university hospital. Methods Thirty-two patients with ILD, evaluated at dedicated MDT were referred to a rheumatologist in 2018, usually for autoantibodies positivity or clinical history suspected for a rheumatological disorder. Rheumatologic evaluation included physical examination, routinary blood and urine tests, serum levels of C3 and C4, ANA, Rheumatoid Factor (RF), ANCAs, anti-Sm, anti-RNP, anti-Ro/SSA, anti-La/SSB, anti-Sm, anti-Jo1, anti-dsDNA and anti-CCP antibodies. Family history of autoimmune diseases, presence of rheumatologic red flags (Raynaud’s phenomenon, photosensitivity, inflammatory skin manifestations, sicca syndrome, recurrent fever, inflammatory arthralgias, paresthesias, oral or genital aphthosis, thrombosis and recurrent miscarriages), respiratory symptoms and pulmonary function test were also evaluated. When indicated, capillaroscopy, joint imaging and salivary gland biopsy were performed. Results Twenty-one patients (65.6%) were female. At the time of rheumatological evaluation, the patients had a mean age of 64.4±12.6 years with a mean period of 21.1±39.6 months since the first identification of ILD on a CT scan. Twenty-five (78.1%) and 18 (56.3%) patients respectively complained exertional dyspnea and cough, 6 patients (18.8%) were on oxygen therapy and 13 (40.6%) had a FVC Conclusion Single clinical or laboratory abnormalities are not strongly associated to a rheumatological diagnosis in patients with ILD, suggesting that only a comprehensive rheumatological evaluation allows correct classification of the disease associated with ILD and is mandatory to make or exclude a diagnosis. In this study, we evaluated only preselected patients by ILD-MDT, but the results indirectly suggest that direct participation of rheumatologist to MDT is advisable to increase accuracy and reduce delay in diagnosis and treatment. Disclosure of Interests: Enrico De Lorenzis: None declared, Gerlando Natalello: None declared, Lucrezia Verardi: None declared, Silvia Laura Bosello: None declared, Elisa Gremese Consultant for: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Sanofi, UCB, Roche, and Pfizer, Speakers bureau: BMS, Speakers bureau: Roche, Speakers bureau: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Sanofi, UCB, Roche, and Pfizer