Interstitielle Lungenerkrankung bei systemischen autoimmunen rheumatischen Erkrankungen: Update zu Diagnostik und Monitoring

Patients with systemic autoimmune rheumatic diseases (SARD) have an increased risk of developing interstitial lung disease (ILD), which often determines the prognosis. Guidelines for screening and monitoring, which are particularly relevant due to the high risk of mortality and the growing number of pharmacological therapeutic options, were not available for a long time. However, American guidelines were recently published and European recommendations will be available soon. For screening of asymptomatic high-risk patients or symptomatic patients, the combination of high-resolution computed tomography (HRCT) of the chest and pulmonary function test is recommended. Optionally, ambulatory oxygen measurements can also be performed. The same approach applies to monitoring when SARD-ILD is diagnosed, although there are no clear recommendations for serial imaging using HRCT of the chest. There is a lack of good quality data on the frequency of rescreening and monitoring; thus, an individual assessment based on risk factors is recommended. This article places the currently available recommendations in a larger context and considers recent data. An interdisciplinary and interprofessional team should carry out the management of these patients given the complexity and sometimes rarity of these disorders.