Interstitial Pneumonia with Autoimmune Features: Why Rheumatologist-Pulmonologist Collaboration Is Essential

In 2015 the European Respiratory Society (ERS) and the American Thoracic Society (ATS) Task Force on Undifferentiated Forms of Connective Tissue Disease-associated Interstitial Lung Disease proposed classification criteria for a new research category defined as Interstitial Pneumonia with Autoimmune Features (IPAF), to uniformly define patients with interstitial lung disease (ILD) and features of autoimmunity, without a definite connective tissue disease. These classification criteria were based on a variable combination of features obtained from three domains: a clinical domain consisting of extra-thoracic features, a serologic domain with specific autoantibodies, and a morphologic domain with imaging patterns, histopathological findings, or multicompartment involvement. Features suggesting a systemic vasculitis were excluded. Since publication of ERS/ATS IPAF research criteria, various retrospective studies have been published focusing on prevalence; clinical, morphological, and serological features; and prognosis of these patients showing a broad heterogeneity in the results. Recently, two prospective, cohort studies were performed, confirming the existence of some peculiarities for this clinical entity and the possible progression of IPAF to a defined connective tissue disease (CTD) in about 15% of cases. Moreover, a non-specific interstitial pneumonia pattern, an anti-nuclear antibody positivity, and a Raynaud phenomenon were the most common findings. In comparison with idiopathic pulmonary fibrosis (IPF), IPAF patients showed a better performance in pulmonary function tests and less necessity of oxygen delivery. However, at this stage of our knowledge, we believe that further prospective studies, possibly derived from multicenter cohorts and through randomized control trials, to further validate the proposed classification criteria are needed.

Automated summary

Since 2015, there has been significant attention on research related to IPAF, including studies on prevalence, clinical features, pathological features, and prognosis. Recent studies have found that about 15% of IPAF patients may progress to a defined connective tissue disease, and compared to idiopathic pulmonary fibrosis, IPAF patients show better performance in pulmonary function tests and oxygen delivery requirements. Further prospective studies, potentially derived from multicenter cohorts and randomized control trials, are needed to validate the proposed classification criteria.