Cardiovascular Involvement in Connective Tissue Disease: The Role of Interstitial Lung Disease

Wang, Xiaobing; Lou, MeiNa; Li, Yongji; Ye, Wen-Jing; Zhang, Zhiyong; Jia, Xiaoyang; Shi, Honglian; Zhu, Xiongzhao; Wang, Liangxing

doi:10.1371/journal.pone.0121976

Cited by 10 publications

(16 citation statements)

References 37 publications

(39 reference statements)

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“…Pulmonary vascular disease is a common comorbidity in CTD, and a major cause of mortality especially in patients with SSc [9,10,11]. Cardiovascular disease is increased in prevalence in patients with CTDs and is associated with ILD [12]. Worsening cough and purulent sputum production are suggestive of acute or sub-acute pulmonary infection, but in patients receiving immunosuppressive therapy, an infection may manifest solely as worsening dyspnoea.…”

Section: Symptomatic Change In Monitoringmentioning

confidence: 99%

Monitoring of Lung Involvement in Rheumatologic Disease

Paschalaki

Jacob²,

Wells

2016

Respiration

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The monitoring of lung involvement in patients with connective tissue diseases is central to optimal long-term management and is directed towards: (a) the detection of supervening lung involvement not present at presentation and (b) the identification of disease progression in established lung disease. For both goals, accurate surveillance requires multi-disciplinary evaluation with the integration of symptomatic change, serial pulmonary function trends and imaging data. Evaluated in isolation, each of these monitoring domains has significant limitations. Symptomatic change may be confounded by a wide variety of systemic factors. Pulmonary function tests provide the most reliable data, but are limited by measurement variability, the heterogeneity of functional patterns and the confounding effects of non-pulmonary factors. Chest radiography is insensitive to change but may provide rapid confirmation of major disease progression or alert the clinician to respiratory co-morbidities. Although high-resolution computed tomography has a central role in assessing disease severity, it should be used very selectively as a monitoring tool due to the associated radiation burden. Ancillary tests include echocardiography and exercise testing to proactively identify cases of pulmonary hypertension and worsening of oxygenation. In summary, a multi-disciplinary approach is essential for the identification of disease progression and prompt treatment of comorbidities that severely impact on the morbidity and mortality of disease.

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Section: Symptomatic Change In Monitoringmentioning

confidence: 99%

Monitoring of Lung Involvement in Rheumatologic Disease

Paschalaki

Jacob²,

Wells

2016

Respiration

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“…Cardiovascular events are the major cause of premature death in these patients. Accelerated atherosclerosis is considered the primary cause of cardiovascular diseases and side effects of immunotherapy can also contribute to these diseases [2,14].…”

Section: Clinical Featuresmentioning

confidence: 99%

“…Renal involvement as concomitant manifestation was present mostly in patients with SLE and in 16 patients with vasculitis, renal failure confirmed generalized form of disease [16].Three patients with collagen vascular diseases at time of analysis had diagnosed carcinoma but none had lung carcinoma. Connective tissue disease represents a large group of disease, which can be associated with carcinoma of different localizations, and most frequently with breast and lung cancers [5,14]. Risk factors for lung cancer development in connective tissue disease are still the subject of basic research.…”

Section: Clinical Featuresmentioning

confidence: 99%

Pleuropulmonary manifestations of systemic autoimmune diseases: An 84-case series analysis

et al. 2020

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Introduction/Objective. The systemic autoimmune diseases (SAD) can cause a variety of pulmonary and pleural abnormalities. The aim of this paper is to review clinical and radiological characteristics of a series of patients with systemic autoimmune disease hospitalized at a tertiary level facility. Methods. In this retrospective study, we reviewed the clinical and imaging findings in patients diagnosed with SAD at the Teaching Hospital of Pulmonology during a nine-year period. Results. The 84 patients group (mean age of 53.8 years) consisted of 64 women and 20 men. Fifty-eight out of 84 patients suffered from collagen vascular disease (CVD) and 26/84 had systemic vasculitis. Fatigue was a dominant symptom (75.8% in CVD, and 69.2% in vasculitis). Cough, hemoptysis, and fever were more frequent in patients with vasculitis. Fibrosis was the most common radiological manifestation of CVD (26/58), followed by pleural effusion (18/58) and consolidation (10/58). Irregular opacities were dominant radiologic finding in vasculitis (10/26), followed by nodules (8/26). Histological confirmation of systemic autoimmune disease was obtained in 28.6% patients, in 58/84 patients the diagnosis was based on positive serologic test and clinico-radiological manifestations, in two cases, on clinical and radiological features according to defined criteria. Conclusion. Pleuropulmonary manifestations of systemic autoimmune diseases are usually expressed in the sixth decade of age, predominantly in women. Clinical findings and positive serologic tests suggest diagnosis of systemic autoimmune diseases. Fibrosis is the most common radiologic pattern found in almost a half of the patients with CVD and irregular opacities are most common findings in vasculitis. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175046]

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“…Exertional dyspnea may also be aggravated by the coexistent pulmonary vascular, extrapulmonic restrictive, and airway complications of CTD, discussed earlier, and also by cardiovascular disease, which is increased in prevalence in patients with CTD-ILD. 51 Thus, worsening dyspnea should not be interpreted in isolation in CTD-ILD.…”

Section: Multidisciplinary Evaluation Of Ctd-ild Progressionmentioning

confidence: 99%

Multidisciplinary Evaluation in Patients with Lung Disease Associated with Connective Tissue Disease

Wells

Devaraj

Renzoni

et al. 2019

Semin Respir Crit Care Med

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Multidisciplinary diagnosis is now viewed as the diagnostic reference standard in interstitial lung disease (ILD). This process consists of the integration of the evidence base with clinical reasoning in the formulation of a diagnosis and requires input from clinicians, radiologists, and, in selected cases, histopathologists. In ILD associated with connective tissue disease (CTD-ILD), multidisciplinary evaluation is especially helpful when CTD is suspected but cannot be diagnosed using strict criteria. In this context, the integration of systemic clinical data, serologic information, and computed tomography and biopsy findings may allow CTD-ILD to be diagnosed. However, the value of multidisciplinary evaluation in CTD-ILD is not confined to diagnosis. The frequent coexistence of pulmonary processes other than ILD, including pulmonary vascular disease, extrapulmonic restriction, and airways disease, often has a major impact on symptoms and pulmonary function tests (PFTs). In this review, we highlight the value of multidisciplinary discussion (MDD) in reconciling clinical data, PFT, and imaging data in the accurate staging of disease severity, baseline prognostic evaluation, and the identification of progression of ILD. MDD also provides a means to combine the views of respiratory physicians and rheumatologists in formulating a treatment strategy. It is often possible to reach a robust view as to whether management should be driven by systemic disease, pulmonary disease, or both. When treatment needs to be introduced or modified for both systemic and pulmonary reasons, face-to-face discussion facilities the selection of therapeutic agents that are likely to be efficacious for both systemic and pulmonary diseases.

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Cardiovascular Involvement in Connective Tissue Disease: The Role of Interstitial Lung Disease

Cited by 10 publications

References 37 publications

Monitoring of Lung Involvement in Rheumatologic Disease

Monitoring of Lung Involvement in Rheumatologic Disease

Pleuropulmonary manifestations of systemic autoimmune diseases: An 84-case series analysis

Multidisciplinary Evaluation in Patients with Lung Disease Associated with Connective Tissue Disease

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