2023 American College of Rheumatology (ACR)/American College of Chest Physicians (CHEST) Guideline for the Screening and Monitoring of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Diseases
Authors: Johnson Sindhu R. , Bernstein Elana J. , Bolster Marcy B. , Chung Jonathan H. , Danoff Sonye K. , George Michael D. , Khanna Dinesh , Guyatt Gordon , Mirza Reza D. , Aggarwal Rohit , Allen Aberdeen , Assassi Shervin , Buckley Lenore , Chami Hassan A. , Corwin Douglas S. , Dellaripa Paul F. , Domsic Robyn T. , Doyle Tracy J. , Falardeau Catherine Marie , Frech Tracy M. , Gibbons Fiona K. , Hinchcliff Monique , Johnson Cheilonda , Kanne Jeffrey P. , Kim John S. , Lim Sian Yik , Matson Scott , McMahan Zsuzsanna H. , Merck Samantha J. , Nesbitt Kiana , Scholand Mary Beth , Shapiro Lee , Sharkey Christine D. , Summer Ross , Varga John , Warrier Anil , Agarwal Sandeep K. , Antin‐Ozerkis Danielle , Bemiss Bradford , Chowdhary Vaidehi , Dematte D'Amico Jane E. , Hallowell Robert , Hinze Alicia M. , Injean Patil A. , Jiwrajka Nikhil , Joerns Elena K. , Lee Joyce S. , Makol Ashima , McDermott Gregory C. , Natalini Jake G. , Oldham Justin M. , Saygin Didem , Lakin Kimberly Showalter , Singh Namrata , Solomon Joshua J. , Sparks Jeffrey A. , Turgunbaev Marat , Vaseer Samera , Turner Amy , Uhl Stacey , Ivlev Ilya 
Published: July 2024

Objective

We provide evidence‐based recommendations regarding screening for interstitial lung disease (ILD) and the monitoring for ILD progression in people with systemic autoimmune rheumatic diseases (SARDs), specifically rheumatoid arthritis, systemic sclerosis, idiopathic inflammatory myopathies, mixed connective tissue disease, and Sjögren disease.

Methods

We developed clinically relevant population, intervention, comparator, and outcomes questions related to screening and monitoring for ILD in patients with SARDs. A systematic literature review was performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology. A Voting Panel of interdisciplinary clinician experts and patients achieved consensus on the direction and strength of each recommendation.

Results

Fifteen recommendations were developed. For screening people with these SARDs at risk for ILD, we conditionally recommend pulmonary function tests (PFTs) and high‐resolution computed tomography of the chest (HRCT chest); conditionally recommend against screening with 6‐minute walk test distance (6MWD), chest radiography, ambulatory desaturation testing, or bronchoscopy; and strongly recommend against screening with surgical lung biopsy. We conditionally recommend monitoring ILD with PFTs, HRCT chest, and ambulatory desaturation testing and conditionally recommend against monitoring with 6MWD, chest radiography, or bronchoscopy. We provide guidance on ILD risk factors and suggestions on frequency of testing to evaluate for the development of ILD in people with SARDs.

Conclusion

This clinical practice guideline presents the first recommendations endorsed by the American College of Rheumatology and American College of Chest Physicians for the screening and monitoring of ILD in people with SARDs.