title: The use of auto-antibody testing in the evaluation of interstitial lung disease (ILD)--A practical approach for the pulmonologist.
abstract: Interstitial lung diseases (ILD), also defined as diffuse parenchymal lung diseases (DPLD) include a heterogeneous group of pulmonary disorders. They may be caused by an underlying connective tissue disease (CTD), Rheumatoid Arthritis (RA) or ANCA-associated Vasculitis (AAV). Pulmonary manifestations of these conditions may also precede systemic onset and therefore, pulmonologists may be confronted with diagnosing a systemic rheumatic disease. For the discrimination of CTD-related ILD and idiopathic interstitial pneumonia (IIP), serological testing is recommended. After careful reviewing the available literature, we suggest a serologic diagnostic algorithm for pulmonologists dealing with ILD-patients. This algorithm depicts the consensus for antibody testing that was reached amongst authors. Obviously this consensus approach requires further validation in everyday practice and leaves room for local adaption of the diagnostic strategy depending on the availability of diagnostic capacity and cost. It is our hope, however, that the rational and stepwise approach of serological testing for ILD will ultimately save unnecessary expenses associated with general laboratory screening. Finally a broader consensus on the strategy for laboratory testing in ILD in general might also improve the detection level of these relatively rare diseases and this will ultimately improve management and care of patients suffering from these complex disorders.
authors.affiliation: LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Woehrendamm 80, 22927 Grosshansdorf, Germany. Electronic address: t.bahmer@lungenclinic.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bahmer
authors.affiliation: Pulmonology Unit, S'Orsola-Malpighi Hospital, University of Bologna, via Albertoni 15, 40138 Bologna, Italy.
authors.forename: Micaela
authors.initials: M
authors.lastname: Romagnoli
authors.affiliation: Rheumatology Unit, Internal Medicine Department, GB Morgagni - L Pierantoni Hospital, Via Carlo Forlanini 34, 47121 Forlì, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Girelli
authors.affiliation: LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Woehrendamm 80, 22927 Grosshansdorf, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Claussen
authors.affiliation: LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Woehrendamm 80, 22927 Grosshansdorf, Germany.
authors.forename: Klaus F
authors.initials: KF
authors.lastname: Rabe
mesh_terms: D000465:Algorithms; D001323:Autoantibodies / Q000737:chemistry / Q000276:immunology*; D042241:Early Diagnosis; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D000072106:Pulmonologists; D012680:Sensitivity and Specificity
chemical_list: D001323:Autoantibodies
keywords: ANA fluorescence pattern; CTD-ILD; Diagnostic algorithm; IPAF; IPF; Serological testing