Diagnostic delay of associated interstitial lung disease increases mortality in rheumatoid arthritis

Cano-Jiménez, Esteban; Rodriguez, Tomas Vazquez; Martín-Robles, Irene; Villegas, Diego Castillo; García, Javier Juan; Miguel, Elena Bollo de; Robles-Pérez, Alejandro; Galván, Marta Ferrer; Roibas, Cecilia Mouronte; Lara, Susana Herrera; Bermudo, Guadalupe; Moyano, Marta García; Portal, José Antonio Rodríguez; Torres, J. Sellares; Narváez, Javier; Molina-Molina, María

doi:10.1038/s41598-021-88734-2

Cited by 35 publications

(15 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“… 41 – 43 Delay in referral to speciality centres has been associated with increased mortality in interstitial lung disease. 44 , 45 Our findings are corroborated by the results of a European survey of patients with idiopathic pulmonary fibrosis who also described a protracted route to obtaining a diagnosis. 46 In this survey, patients viewed their initial diagnosis of asthma, COPD or pneumonia, not as a working hypothesis, but as an error or misdiagnosis.…”

Section: What Is Already Knownsupporting

confidence: 80%

When should palliative care be introduced for people with progressive fibrotic interstitial lung disease? A meta-ethnography of the experiences of people with end-stage interstitial lung disease and their family carers

et al. 2022

View full text Add to dashboard Cite

Background: Little is currently known about the perspectives of people with interstitial lung disease and their carers in relation to the timing of palliative care conversations. Aim: To establish patients’ and carers’ views on palliative care in interstitial lung disease and identify an optimum time to introduce the concept of palliative care. Design: Meta-ethnography of qualitative evidence. The review protocol was prospectively registered with PROSPERO (CRD42021243179). Data sources: Five electronic healthcare databases were searched (Medline, Embase, CINAHL, Scopus and Web of Science) from 1st January 1996 to 31st March 2022. Studies were included that used qualitative methodology and included patients’ or carers’ perspectives on living with end-stage disease or palliative care. Quality was assessed using the Critical Appraisal Skills Programme checklist. Results: About 1779 articles were identified by initial searches. Twelve met the inclusion criteria, providing evidence from 266 individuals across five countries. Three stages were identified in the illness journey of a person with interstitial lung disease: (1) Information seeking, (2) Grief and adjustment, (3) Fear of the future. Palliative care involvement was believed to be most appropriate in the latter two stages and should be prompted by changes in patients’ health such as respiratory infections, onset of new symptoms, hospital admission, decline in physical function and initiation of oxygen. Conclusions: Patients and carers prefer referral to palliative care services to be prompted by changes in health status. Future research should focus on supporting timely recognition of changes in patients’ health status and how to respond in a community setting.

show abstract

Section: What Is Already Knownsupporting

confidence: 80%

When should palliative care be introduced for people with progressive fibrotic interstitial lung disease? A meta-ethnography of the experiences of people with end-stage interstitial lung disease and their family carers

et al. 2022

View full text Add to dashboard Cite

show abstract

“…As our cohort showed generally better baseline pulmonary function than those of previous studies, 32 we may assume that this study cohort includes more patients who diagnosed ILD in early stage. Recent study suggests that delayed diagnosis of RA-ILD associated with an increased mortality, 33 and, thus, diagnosing RA-ILD in early stage might have resulted in lower mortality in our cohort.…”

Section: Discussionmentioning

confidence: 70%

Protective effect of methotrexate on lung function and mortality in rheumatoid arthritis–related interstitial lung disease: a retrospective cohort study

Kim

Woo

Park

et al. 2022

Ther Adv Respir Dis

View full text Add to dashboard Cite

Background: Studies on the risk and protective factors for lung function decline and mortality in rheumatoid arthritis–related interstitial lung disease (RA-ILD) are limited. Objectives: We aimed to investigate clinical factors and medication uses associated with lung function decline and mortality in RA-ILD. Methods: This retrospective cohort study examined the medical records of patients with RA-ILD who visited Severance Hospital between January 2006 and December 2019. We selected 170 patients with RA-ILD who had undergone at least one spirometry test and chest computed tomography scan. An absolute decline of ⩾10% in the functional vital capacity (FVC) was defined as significant decline in pulmonary function. Data for analysis were retrieved from electronic medical records. Results: Ninety patients (52.9%) were female; the mean age was 64.0 ± 10.2 years. Multivariate logistic regression showed that a high erythrocyte sediment rate level at baseline [odds ratio (OR) = 3.056; 95% confidence interval (CI) = 1.183–7.890] and methotrexate (MTX) use (OR = 0.269; 95% CI = 0.094–0.769) were risk and protective factors for lung function decline, respectively. Multivariate Cox regression analysis indicated that age ⩾65 years (OR = 2.723; 95% CI = 1.142–6.491), radiologic pattern of usual interstitial pneumonia (UIP) or probable UIP (OR = 3.948; 95% CI = 1.522–10.242), baseline functional vital capacity (FVC) % predicted (OR = 0.971; 95% CI = 0.948–0.994), and MTX use (OR = 0.284; 95% CI = 0.091–0.880) were predictive of mortality. Conclusion: We identified risk and protective factors for lung function decline and mortality in patients with RA-ILD. MTX use was associated with favorable outcome in terms of both lung function and mortality in our cohort.

show abstract

“…Current research in non-ARD ILDs has shown that significant diagnostic delay is often caused by factors such as misdiagnosis, underreporting of ILD features on imaging and prolonged referral time to ILD specialists, even when ILD is reported [ 14–17 ]. Similarly, previous studies on ARD-ILD have found that the time from symptom debut to diagnosis is delayed and that diagnostic delay is associated with disease progression and increased mortality [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 71%

The diagnostic trajectories of Danish patients with autoimmune rheumatologic disease associated interstitial lung disease: an interview-based study

Johansen

Bendstrup

Davidsen

et al. 2023

European Clinical Respiratory Journal

View full text Add to dashboard Cite

Background Autoimmune rheumatologic disease associated interstitial lung diseases (ARD-ILD) are rare conditions and the association between ARDs and respiratory symptoms often goes unrecognised by ARD patients and general practitioners (GPs). The diagnostic trajectory from the first respiratory symptoms to an ARD-ILD diagnosis is often delayed and may increase the burden of symptoms and allow further disease progression.The aim of this study was to 1) characterise the diagnostic trajectories of ARD-ILD patients and to 2) identify barriers for obtaining a timely ILD diagnosis based on the experiences and perceptions of both patients and healthcare professionals. Method Semi-structured qualitative interviews were conducted with Danish ARD-ILD patients, rheumatologists, pulmonologists and ILD nurses. Results Sixteen patients, six rheumatologists, three ILD nurses and three pulmonologists participated. Five characteristics of diagnostic trajectories were identified in the patient interviews: 1) early referral to lung specialists; 2) early delay; 3) delay or shortcut depending on specific circumstances; 4) parallel diagnostic trajectories connected late in the process; 5) early identification of lung involvement without proper interpretation. With the exception of early referral to lung specialists, all of the diagnostic trajectory characteristics identified led to delayed diagnosis. Delayed diagnostic trajectories resulted in patients experiencing increased uncertainty. Inconsistent disease terminology, insufficient knowledge and lack of awareness of ARD-ILD among central healthcare professionals and delayed referral to ILD specialists were main contributors to the diagnostic delay identified by the informants. Conclusion Five characteristics of the diagnostic trajectories were identified, four of which led to diagnostic delay of ARD-ILD. Improved diagnostic trajectories can shorten the diagnostic trajectory and increase early access to appropriate specialist medical care. Improved awareness and expertise in ARD-ILD across different medical specialties, especially among GPs, may contribute to more efficient and timely diagnostic trajectories and improved patient experiences.

show abstract

Diagnostic delay of associated interstitial lung disease increases mortality in rheumatoid arthritis

Cited by 35 publications

References 46 publications

When should palliative care be introduced for people with progressive fibrotic interstitial lung disease? A meta-ethnography of the experiences of people with end-stage interstitial lung disease and their family carers

When should palliative care be introduced for people with progressive fibrotic interstitial lung disease? A meta-ethnography of the experiences of people with end-stage interstitial lung disease and their family carers

Protective effect of methotrexate on lung function and mortality in rheumatoid arthritis–related interstitial lung disease: a retrospective cohort study

The diagnostic trajectories of Danish patients with autoimmune rheumatologic disease associated interstitial lung disease: an interview-based study

Contact Info

Product

Resources

About