Progressive Fibrosing Interstitial Lung Disease: from Bench to Bedside

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Cover image for research topic "Progressive Fibrosing Interstitial Lung Disease: from Bench to Bedside"
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Review
13 June 2023
Myositis interstitial lung disease and autoantibodies
Shire Chaudhry
 and 
Lisa Christopher-Stine
MSA’s interposed onto the IIM’s; caution symbol denotes more severe disease when anti-Ro autoantibodies are present.

The aim of this review is to examine and evaluate published literature associated with idiopathic inflammatory myopathies (IIM) and interstitial lung disease (ILD) based on myositis specific autoantibodies (MSA) and the potential clinical significance of each autoantibody subtype for the practicing clinician. The review is a comprehensive search of literature published in PubMed from the year 2005 and onward coinciding with the surge in the discovery of new MSAs. Additionally, we comment on recommended multidisciplinary longitudinal care practices for patients with IIM-ILD with regard to imaging and other testing. Treatment is not covered in this review.

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Study flowchart. Cases of silicosis in Shanghai Pulmonary Hospital, Shanghai, China (2011.04–2021.04). AS-associated silicosis group is referred to as AS group; non-AS-associated silicosis group is referred to as non-AS group.
Original Research
04 April 2022

Background: Silicosis poses a threat to workers’ health due to the irreversible lung lesions.

Design: A retrospective cohort study.

Methods: A total of 259 patients [80 worked with artificial stone (AS), 179 with non-artificial stone (non-AS)] with confirmed silicosis were included in this study. Forty-one of AS and 91 of non-AS had approximately 2 years’ follow-up records [lung function tests and high-resolution computer tomography (HRCT)]. Compared with the first records, increased, densified, or newly emerging lesions in lung HRCT images were judged as progression of the disease. Cox proportional hazards models were used to determine the risk factors. Kaplan–Meier survival curve and log-rank test were used to compare prognostic factors for cumulative risk of progression.

Results: In 132 patients with median follow-up of 24.0 months (IQR, 13.8, 24.9), 66 patients showed progression, in them, 36 (87.8%) were from AS group and 30 (32.9%) from non-AS group. Working experience of AS processing (hazard ratio, 5.671; 95% CI, 3.048–10.550) and complicated silicosis in CT images (hazard ratio, 2.373; 95% CI, 1.379–4.082) were the main risk factors associated with progression. Forced vital capacity decreased after 1-year (241.5 vs. 55.2 mL) and 2-year (328.1 vs. 68.8 mL) follow-up in the two groups (AS vs. non-AS). History of anti-tuberculosis medication, chest oppression and pain, ground-glass opacity, pleural abnormalities, and restrictive pulmonary dysfunction were more frequently found on HRCT images in the AS group than non-AS group. Lung functions (DLCO, %) were lower in the current/former smokers than the non-smokers (P < 0.05) in AS patients.

Conclusion: Prevention and protection rules are needed to be enforced in the occupation involving AS processing; smoking may be associated with declined lung function in AS patients.

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