Journal
ARTHRITIS & RHEUMATOLOGY
Volume 70, Issue 12, Pages 1901-1913Publisher
WILEY
DOI: 10.1002/art.40679
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Funding
- NIH (National Center for Advancing Translational Sciences) [UL1-TR-000445]
- NIH (National Institute of Arthritis and Musculoskeletal and Skin Diseases) [T32-AR-007304]
- NIH (National Heart, Lung, and Blood Institute) [K08-HL-130595, P01-HL-92870, R01-HL-085317]
- Francis Family Foundation
- Pulmonary Fibrosis Foundation
- NIH (National Institute of Diabetes and Digestive and Kidney Diseases) [R01-DK-084246]
- Department of Veterans Affairs
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Interstitial lung disease (ILD) remains a cause of significant morbidity and mortality in patients with connective tissue disease (CTD)-associated ILD. While some patients meet clear classification criteria for a systemic rheumatic disease, a subset of patients do not meet classification criteria but still benefit from immunosuppressive therapy. In 2015, the American Thoracic Society and European Respiratory Society described classification criteria for interstitial pneumonia with autoimmune features (IPAF) to identify patients with lung-predominant CTD who lack sufficient features of a systemic rheumatic disease to meet classification criteria. Although these criteria are imperfect, they are an important attempt to classify the patient with undifferentiated disease for future study. Rheumatologists play a key role in the evaluation of potential IPAF in patients, especially as many patients with a myositis-spectrum disease (e.g., non-Jo-1 antisynthetase syndrome, anti-melanoma differentiation-associated protein 5 antibody inflammatory myositis, or anti-PM/Scl antibody-associated inflammatory myositis) would be classified under IPAF using the currently available criteria for inflammatory myositis, and would therefore benefit from rheumatologic comanagement. The aim of this review was to describe the historical context that led to the development of these criteria and to discuss the limitations of the current criteria, diagnostic challenges, treatment options, and strategies for disease monitoring.
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