A clue to diagnosing connective tissue disease-associated interstitial lung disease.

摘要

In a recent issue of CHEST (August 2010), Fischer and coworkers discussed the dilemmas surrounding the classification of a patient with interstitial pneumonia (IP) whose clinical features suggested an associated connective tissue disease (CTD) but did not provide a clear diagnosis of CTD-associated interstitial lung disease (ILD) on the basis of current rheumatologic classification systems. Undeniably, current rheumatologic classification schemes are limiting because they do not allow CTD designation when IP is the lone manifestation. We agree with the authors that the detection of occult CTD in patients presenting with IP is optimized by multidisciplinary collaboration. It is very difficult to differentiate idiopathic pulmonary fibrosis from CTD-ILD before the appearance of their systematic manifestations. However, several autoantibodies have been identified as being of diagnostic significance for CTD and may serve as clues for a new CTD-ILD classification.