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Publication Detail
Management of interstitial lung disease (ILD) in myositis syndromes: A practical guide for clinicians
  • Publication Type:
    Journal article
  • Authors:
    Mehta P, Aggarwal R, Porter JC, Gunawardena H
  • Publisher:
    Elsevier BV
  • Publication date:
    07/2022
  • Journal:
    Best Practice & Research Clinical Rheumatology
  • Article number:
    101769
  • Status:
    Accepted
  • Language:
    English
  • Keywords:
    Myositis, Interstitial lung disease, Management, Inflammatory myopathies
  • Notes:
    This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third-party material in this article are included in the Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/
Abstract
Inflammatory myopathies are heterogeneous clinico-serological syndromes, with variable clinical manifestations. Interstitial lung disease (ILD) is a major cause of morbidity and mortality in patients with myositis. The clinical manifestation of myositis-ILD is heterogeneous, e.g., with acute-on-chronic presentations, as well as the chronic aftermath of acute disease. Here, we have largely divided myositis-ILD into three main prognostic groups which require different treatment approaches: mild-moderate (subacute), severe or progressive (acute or subacute) and rapidly progressive, life-threatening. In current clinical practice, the treatment of myositis-ILD involves immunomodulation in an induction-maintenance treatment paradigm. There is now an option to add antifibrotics to slow the progression of established fibrosis in selected cases with chronic progressive phenotype. Here, we describe current concepts in myositis-ILD and aim to provide a practical guide for clinicians on how to approach assessment, including early identification of ILD, phenotyping of patients according to clinical trajectory and likely prognosis and stratified management adopting multi-disciplinary cross-speciality expertise, with close collaboration between rheumatology and respiratory physicians.
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