The impact of rheumatological evaluation in the management of patients with interstitial lung disease.
OBJECTIVE
We hypothesized that multi-disciplinary assessment of patients with interstitial lung disease (ILD) would lead to improved diagnosis and management.


METHODS
Our multi-disciplinary ILD group evaluated 50 patients referred to our tertiary care practice over a 12-month period. Evaluation consisted of independent assessments by a pulmonologist and rheumatologist, including complete history and physical examination, review of laboratory data, as well as review of imaging and pathological specimens in conjunction with a radiologist and pathologist experienced in ILD. Therapy was initiated or changed in collaboration with the referring physicians.


RESULTS
Mean age was 65 years for patients with rheumatic or CTD-related ILD (CTD-ILD) and 70 years for those with idiopathic pulmonary fibrosis (IPF). The final diagnosis after evaluation in the clinic was 25 patients with CTD-ILD, 15 patients with IPF and 10 patients with other forms of lung disease. Of the patients with a final diagnosis of CTD-ILD, 28% were referred with a diagnosis of IPF. Among those referred with CTD-ILD, 36% had their diagnosis changed to an alternate CTD-ILD. In total, the diagnosis was changed in 54% of patients who presented to the ILD clinic. Changes in therapy occurred in 80% of patients with CTD-ILD and in 27% of patients with IPF.


CONCLUSIONS
A multi-disciplinary ILD clinic offers patients an innovative mode of health-care delivery that can enhance diagnosis, affect treatment regimens and improve quality of care. Rheumatologists play a significant role in the clinical care of these patients and should evaluate all patients with ILD.
Castelino
Flavia V
FV
Department of Medicine, Division of Rheumatology, Massachussetts General Hospital, 55 Fruit Street, Bulfinch-165, Boston, MA 02114, USA. fcastelino@partners.org
Goldberg
Hilary
H
Dellaripa
Paul F
PF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team