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LIVERPOOL, ENGLAND – Very few patients with idiopathic pulmonary fibrosis have connective tissue disease antibodies, suggesting that IPF is a “robust diagnosis” when made on the basis of standard diagnostic tests, it was reported at the British Society for Rheumatology annual conference.
“The results were perhaps not what we’d expected,” said Caroline V. Cotton, PhD, of the Institute of Ageing and Chronic Disease at the University of Liverpool, England.
This means that chest physicians are getting the diagnosis right in the majority of cases, based on currently available methods, such as patients’ clinical history and examination, the results of high resolution–computed tomography, and widely available serology. “Which is good news,” Dr. Cotton observed.
Interstitial lung disease (ILD) comprises a huge spectrum of disorders. The main groups of ILDs are idiopathic, granulomatous, connective tissue disease–associated environmental, or medication exposure–associated; and the rare causes of ILD, each of which contain multiple subgroups of which IPF is one.
Sometimes it is obvious to respiratory physicians what the cause is, such as environmental exposure to asbestos or sarcoidosis for the granulomatous ILD, Dr. Cotton noted. Identifying connective tissue disease (CTD)–associated ILD can be more diagnostically challenging, however, and there are a large number of rheumatic conditions associated with CTD-associated ILD, including rheumatoid arthritis, systemic sclerosis, and Sjögren’s syndrome, to name a few.
One of the problems is that signs and symptoms of CTD may be absent at the time ILD starts to manifest and, even if signs are present, they may too subtle to be picked up in a general chest clinic. There also is a large number of antibodies for CTDs, but not all are widely available.
Dr. Cotton and her associates, therefore, wondered if there was a chance that patients being diagnosed with IPF actually could have covert CTD-associated ILD; this is an important distinction to make because the treatment differs for the two conditions. While ILD associated with CTD has a strong inflammatory component and is treated with corticosteroids and immunosuppressants, steroids can be harmful and increase mortality in IPF-ILD. The latter is treated with antifibrotic medications, such as pirfenidone and nintedanib.
For the study, serum samples from 250 patients with a definite diagnosis of IPF who were participating in the UK-BILD study were obtained and screened for known CTD antibodies using immunoprecipitation. Antibodies could be detected in just five (2%) patients – these included one patient each with anti-KS and anti-OJ antibodies, which are antisynthetase antibodies that are associated with myositis. Anti-Ku, another myositis-associated antibody, was identified in another patient, and one patient had an anti-RNA polymerase II antibody, which is associated with systemic sclerosis. Antimitochondrial autoantibodies were observed in one patient, and these are linked to primary biliary cirrhosis, which the patient was known to have.
There was nothing remarkable between the patients who did and did not have CTD antibodies in terms of their demographics, 76% and 80% were male, the mean ages were 73 and 70 years, respectively, and all were white.
However, 40% of patients did have unknown strong bands on immunoprecipitation, Dr. Cotton reported. This could suggest that there is an underlying immunological component to IPF, she added, but they had no recognized antibodies.
“A very small number of patients with IPF actually have the presence of autoantibodies strongly associated with CTDs. This suggests IPF is a very robust diagnosis; chest physicians are diagnosing it correctly most of the time, and they are really good at good at weeding out those who have got IPF and those who have potentially got connective tissue disease.” Dr. Cotton concluded.
Dr. Cotton had no conflicts of interest.
SOURCE: Cotton CV et al. Rheumatology. 2018;57[Suppl. 3]:key075.206.
LIVERPOOL, ENGLAND – Very few patients with idiopathic pulmonary fibrosis have connective tissue disease antibodies, suggesting that IPF is a “robust diagnosis” when made on the basis of standard diagnostic tests, it was reported at the British Society for Rheumatology annual conference.
“The results were perhaps not what we’d expected,” said Caroline V. Cotton, PhD, of the Institute of Ageing and Chronic Disease at the University of Liverpool, England.
This means that chest physicians are getting the diagnosis right in the majority of cases, based on currently available methods, such as patients’ clinical history and examination, the results of high resolution–computed tomography, and widely available serology. “Which is good news,” Dr. Cotton observed.
Interstitial lung disease (ILD) comprises a huge spectrum of disorders. The main groups of ILDs are idiopathic, granulomatous, connective tissue disease–associated environmental, or medication exposure–associated; and the rare causes of ILD, each of which contain multiple subgroups of which IPF is one.
Sometimes it is obvious to respiratory physicians what the cause is, such as environmental exposure to asbestos or sarcoidosis for the granulomatous ILD, Dr. Cotton noted. Identifying connective tissue disease (CTD)–associated ILD can be more diagnostically challenging, however, and there are a large number of rheumatic conditions associated with CTD-associated ILD, including rheumatoid arthritis, systemic sclerosis, and Sjögren’s syndrome, to name a few.
One of the problems is that signs and symptoms of CTD may be absent at the time ILD starts to manifest and, even if signs are present, they may too subtle to be picked up in a general chest clinic. There also is a large number of antibodies for CTDs, but not all are widely available.
Dr. Cotton and her associates, therefore, wondered if there was a chance that patients being diagnosed with IPF actually could have covert CTD-associated ILD; this is an important distinction to make because the treatment differs for the two conditions. While ILD associated with CTD has a strong inflammatory component and is treated with corticosteroids and immunosuppressants, steroids can be harmful and increase mortality in IPF-ILD. The latter is treated with antifibrotic medications, such as pirfenidone and nintedanib.
For the study, serum samples from 250 patients with a definite diagnosis of IPF who were participating in the UK-BILD study were obtained and screened for known CTD antibodies using immunoprecipitation. Antibodies could be detected in just five (2%) patients – these included one patient each with anti-KS and anti-OJ antibodies, which are antisynthetase antibodies that are associated with myositis. Anti-Ku, another myositis-associated antibody, was identified in another patient, and one patient had an anti-RNA polymerase II antibody, which is associated with systemic sclerosis. Antimitochondrial autoantibodies were observed in one patient, and these are linked to primary biliary cirrhosis, which the patient was known to have.
There was nothing remarkable between the patients who did and did not have CTD antibodies in terms of their demographics, 76% and 80% were male, the mean ages were 73 and 70 years, respectively, and all were white.
However, 40% of patients did have unknown strong bands on immunoprecipitation, Dr. Cotton reported. This could suggest that there is an underlying immunological component to IPF, she added, but they had no recognized antibodies.
“A very small number of patients with IPF actually have the presence of autoantibodies strongly associated with CTDs. This suggests IPF is a very robust diagnosis; chest physicians are diagnosing it correctly most of the time, and they are really good at good at weeding out those who have got IPF and those who have potentially got connective tissue disease.” Dr. Cotton concluded.
Dr. Cotton had no conflicts of interest.
SOURCE: Cotton CV et al. Rheumatology. 2018;57[Suppl. 3]:key075.206.
LIVERPOOL, ENGLAND – Very few patients with idiopathic pulmonary fibrosis have connective tissue disease antibodies, suggesting that IPF is a “robust diagnosis” when made on the basis of standard diagnostic tests, it was reported at the British Society for Rheumatology annual conference.
“The results were perhaps not what we’d expected,” said Caroline V. Cotton, PhD, of the Institute of Ageing and Chronic Disease at the University of Liverpool, England.
This means that chest physicians are getting the diagnosis right in the majority of cases, based on currently available methods, such as patients’ clinical history and examination, the results of high resolution–computed tomography, and widely available serology. “Which is good news,” Dr. Cotton observed.
Interstitial lung disease (ILD) comprises a huge spectrum of disorders. The main groups of ILDs are idiopathic, granulomatous, connective tissue disease–associated environmental, or medication exposure–associated; and the rare causes of ILD, each of which contain multiple subgroups of which IPF is one.
Sometimes it is obvious to respiratory physicians what the cause is, such as environmental exposure to asbestos or sarcoidosis for the granulomatous ILD, Dr. Cotton noted. Identifying connective tissue disease (CTD)–associated ILD can be more diagnostically challenging, however, and there are a large number of rheumatic conditions associated with CTD-associated ILD, including rheumatoid arthritis, systemic sclerosis, and Sjögren’s syndrome, to name a few.
One of the problems is that signs and symptoms of CTD may be absent at the time ILD starts to manifest and, even if signs are present, they may too subtle to be picked up in a general chest clinic. There also is a large number of antibodies for CTDs, but not all are widely available.
Dr. Cotton and her associates, therefore, wondered if there was a chance that patients being diagnosed with IPF actually could have covert CTD-associated ILD; this is an important distinction to make because the treatment differs for the two conditions. While ILD associated with CTD has a strong inflammatory component and is treated with corticosteroids and immunosuppressants, steroids can be harmful and increase mortality in IPF-ILD. The latter is treated with antifibrotic medications, such as pirfenidone and nintedanib.
For the study, serum samples from 250 patients with a definite diagnosis of IPF who were participating in the UK-BILD study were obtained and screened for known CTD antibodies using immunoprecipitation. Antibodies could be detected in just five (2%) patients – these included one patient each with anti-KS and anti-OJ antibodies, which are antisynthetase antibodies that are associated with myositis. Anti-Ku, another myositis-associated antibody, was identified in another patient, and one patient had an anti-RNA polymerase II antibody, which is associated with systemic sclerosis. Antimitochondrial autoantibodies were observed in one patient, and these are linked to primary biliary cirrhosis, which the patient was known to have.
There was nothing remarkable between the patients who did and did not have CTD antibodies in terms of their demographics, 76% and 80% were male, the mean ages were 73 and 70 years, respectively, and all were white.
However, 40% of patients did have unknown strong bands on immunoprecipitation, Dr. Cotton reported. This could suggest that there is an underlying immunological component to IPF, she added, but they had no recognized antibodies.
“A very small number of patients with IPF actually have the presence of autoantibodies strongly associated with CTDs. This suggests IPF is a very robust diagnosis; chest physicians are diagnosing it correctly most of the time, and they are really good at good at weeding out those who have got IPF and those who have potentially got connective tissue disease.” Dr. Cotton concluded.
Dr. Cotton had no conflicts of interest.
SOURCE: Cotton CV et al. Rheumatology. 2018;57[Suppl. 3]:key075.206.
REPORTING FROM RHEUMATOLOGY 2018
Key clinical point: Few patients diagnosed as having idiopathic pulmonary fibrosis (IPF) are likely to have connective tissue disorders (CTD).
Major finding: Only 2% of patients had a recognized CTD antibody present.
Study details: 250 patients with IPF participating in the UK-BILD multicenter study.
Disclosures: Dr. Cotton stated she had no conflicts of interest.
Source: Cotton CV et al. Rheumatology. 2018;57(Suppl. 3):key075.206.