Significance of connective tissue disease features in idiopathic interstitial pneumonia

T. J. Corte, S. J. Copley, S. R. Desai, C. J. Zappala, D. M. Hansell, A. G. Nicholson, T. V. Colby, E. Renzoni, T. M. Maher, A. U. Wells

Research output: Contribution to journalArticle

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Abstract

In idiopathic interstitial pneumonia (IIP), the significance of connective tissue disease (CTD) features in the absence of a specific CTD diagnosis remains unclear. We studied the clinical and prognostic utility of a diagnosis of undifferentiated CTD (UCTD) in patients with biopsy-proven IIP. IIP patients undergoing surgical lung biopsy (1979-2005) were studied (nonspecific interstitial pneumonia (NSIP), n=45; idiopathic pulmonary fibrosis, n=56). UCTD was considered present when serum autoantibodies were present and symptoms or signs suggested CTD. The relationship between UCTD and NSIP histology was evaluated. A clinical algorithm that best predicted NSIP histology was constructed using a priori variables. The prognostic utility of UCTD, and of this algorithm, was evaluated. UCTD was present in 14 (31%) NSIP and seven (13%) IPF patients. UCTD was not associated with a survival benefit. The algorithm predictive of NSIP (OR 10.4, 95% CI 3.21-33.67; p<0.0001) consisted of the absence of typical high-resolution computed tomography (HRCT) features for IPF and 1) a compatible demographic profile (females aged <50 yrs) or 2) Raynaud's phenomenon. In patients with an HRCT scan not typical for IPF, this algorithm predicted improved survival (hazard ratio 0.35, 95% CI 0.14-0.85; p=0.02) independent of IIP severity. UCTD is associated with NSIP histology. However, the diagnostic and prognostic significance of UCTD in IIP patients remains unclear. Copyright

Original languageEnglish (US)
Pages (from-to)661-668
Number of pages8
JournalEuropean Respiratory Journal
Volume39
Issue number3
DOIs
StatePublished - Mar 1 2012

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Idiopathic Interstitial Pneumonias
Connective Tissue Diseases
Interstitial Lung Diseases
Histology
Tomography
Biopsy
Idiopathic Pulmonary Fibrosis
Raynaud Disease
Survival
Autoantibodies
Signs and Symptoms
Demography
Lung
Serum

Keywords

  • Connective tissue disease
  • Idiopathic interstitial pneumonia
  • Idiopathic pulmonary fibrosis
  • Nonspecific interstitial pneumonia
  • Prognosis
  • Undifferentiated connective tissue disease

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Corte, T. J., Copley, S. J., Desai, S. R., Zappala, C. J., Hansell, D. M., Nicholson, A. G., ... Wells, A. U. (2012). Significance of connective tissue disease features in idiopathic interstitial pneumonia. European Respiratory Journal, 39(3), 661-668. https://doi.org/10.1183/09031936.00174910

Significance of connective tissue disease features in idiopathic interstitial pneumonia. / Corte, T. J.; Copley, S. J.; Desai, S. R.; Zappala, C. J.; Hansell, D. M.; Nicholson, A. G.; Colby, T. V.; Renzoni, E.; Maher, T. M.; Wells, A. U.

In: European Respiratory Journal, Vol. 39, No. 3, 01.03.2012, p. 661-668.

Research output: Contribution to journalArticle

Corte, TJ, Copley, SJ, Desai, SR, Zappala, CJ, Hansell, DM, Nicholson, AG, Colby, TV, Renzoni, E, Maher, TM & Wells, AU 2012, 'Significance of connective tissue disease features in idiopathic interstitial pneumonia', European Respiratory Journal, vol. 39, no. 3, pp. 661-668. https://doi.org/10.1183/09031936.00174910
Corte TJ, Copley SJ, Desai SR, Zappala CJ, Hansell DM, Nicholson AG et al. Significance of connective tissue disease features in idiopathic interstitial pneumonia. European Respiratory Journal. 2012 Mar 1;39(3):661-668. https://doi.org/10.1183/09031936.00174910
Corte, T. J. ; Copley, S. J. ; Desai, S. R. ; Zappala, C. J. ; Hansell, D. M. ; Nicholson, A. G. ; Colby, T. V. ; Renzoni, E. ; Maher, T. M. ; Wells, A. U. / Significance of connective tissue disease features in idiopathic interstitial pneumonia. In: European Respiratory Journal. 2012 ; Vol. 39, No. 3. pp. 661-668.
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abstract = "In idiopathic interstitial pneumonia (IIP), the significance of connective tissue disease (CTD) features in the absence of a specific CTD diagnosis remains unclear. We studied the clinical and prognostic utility of a diagnosis of undifferentiated CTD (UCTD) in patients with biopsy-proven IIP. IIP patients undergoing surgical lung biopsy (1979-2005) were studied (nonspecific interstitial pneumonia (NSIP), n=45; idiopathic pulmonary fibrosis, n=56). UCTD was considered present when serum autoantibodies were present and symptoms or signs suggested CTD. The relationship between UCTD and NSIP histology was evaluated. A clinical algorithm that best predicted NSIP histology was constructed using a priori variables. The prognostic utility of UCTD, and of this algorithm, was evaluated. UCTD was present in 14 (31{\%}) NSIP and seven (13{\%}) IPF patients. UCTD was not associated with a survival benefit. The algorithm predictive of NSIP (OR 10.4, 95{\%} CI 3.21-33.67; p<0.0001) consisted of the absence of typical high-resolution computed tomography (HRCT) features for IPF and 1) a compatible demographic profile (females aged <50 yrs) or 2) Raynaud's phenomenon. In patients with an HRCT scan not typical for IPF, this algorithm predicted improved survival (hazard ratio 0.35, 95{\%} CI 0.14-0.85; p=0.02) independent of IIP severity. UCTD is associated with NSIP histology. However, the diagnostic and prognostic significance of UCTD in IIP patients remains unclear. Copyright",
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AU - Hansell, D. M.

AU - Nicholson, A. G.

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