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Lung

, Volume 197, Issue 3, pp 277–284 | Cite as

Screening for Myositis Antibodies in Idiopathic Interstitial Lung Disease

  • Lee FidlerEmail author
  • Irena Doubelt
  • Sonja Kandel
  • Jolene H. Fisher
  • Shikha Mittoo
  • Shane Shapera
INTERSTITIAL LUNG DISEASE

Abstract

Purpose

International guidelines recommend screening for connective tissue disease (CTD) with autoantibodies when evaluating patients with idiopathic interstitial lung disease (ILD). Idiopathic inflammatory myositis comprises of a subgroup of CTD diagnosed with myositis antibodies (MA), often presenting with ILD. Our aim was to evaluate the utility of MA screening in patients with idiopathic ILD.

Methods

A retrospective analysis was conducted on patients referred with idiopathic ILD to a tertiary centre ILD clinic who were screened for MA. Patients with known or suspected CTD were excluded. Descriptive statistics, univariate analysis and multivariable logistic regression were used to detect associations between MA and patient characteristics.

Results

Of 360 patients, 165 met inclusion criteria and 44 (26.7%) were identified to have MA. Fourteen patients (8.5%) had a change in diagnosis as a result of MA screening. Multivariable logistic regression identified the presence of MA to be associated with current smoking [OR 6.87 (1.65–28.64), p = 0.008] and a diffusing capacity of < 70% predicted [OR 2.55 (1.09–5.97), p = 0.03]. In patients with a change in diagnosis due to MA screening, 3 (1.8%) underwent a surgical lung biopsy and 2 (1.2%) were previously treated with antifibrotic therapy.

Conclusions

Screening for MA in patients with idiopathic ILD can contribute to a change in patient diagnosis, and may prevent invasive testing and unproven use of antifibrotic therapy. These results support the addition of MA to CTD screening panels during the initial evaluation of idiopathic ILD.

Keywords

Connective tissue disease Idiopathic inflammatory myositis Interstitial lung disease 

Abbreviations

ANA

Antinuclear antibodies

ARS

Aminoacyl-tRNA synthetase antibodies

aSS

Antisynthetase syndrome

antiCCP

Anti-cyclic citrullinated peptide

CT

Computed tomography

CTD

Connective tissue disease

DLCO

Diffusing capacity of the lung for carbon monoxide

FVC

Forced vital capacity

GER

Gastroesophageal reflux

IIM

Idiopathic inflammatory myositis

ILD

Interstitial lung disease

IPF

Idiopathic pulmonary fibrosis

MAA

Myositis-associated antibodies

MA

Myositis antibodies

MSA

Myositis-specific antibodies

NSIP

Non-specific interstitial pneumonia

PFT

Pulmonary function testing

RF

Rheumatoid factor

SLB

Surgical lung biopsy

SRP

Anti-signal recognition particle

UIP

Usual interstitial pneumonia

Notes

Author Contributions

LF is the guarantor of this research, and takes responsibility for the integrity of this work. All authors contributed to manuscript revisions, and provided final approval of the version for publication. LF, SS and SM contributed to the study concept and design, statistical analysis, drafting of initial manuscript and study supervision. Other contributions: none.

Funding

Funding for this project was obtained from the Canadian Pulmonary Fibrosis Foundation.

Compliance with Ethical Standards

Conflict of interest

SS has participated in speaking engagements and advisory boards for Hoffman-LaRoche Canada, Boehringer-Ingelheim Canada and AstraZeneca Canada. He has participated in clinical trials research for Hoffman-LeRoche Canada, Boehringer-Ingelheim Canada, Prometic Pharmaceuticals, Gilead Pharmaceuticals and Sanofi-Aventis Canada. All others have no conflicts of interest to declare.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

For this type of study, formal consent is not required.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Medicine, Division of Respirology, University Health NetworkUniversity of TorontoTorontoCanada
  2. 2.Department of MedicineUniversity of TorontoTorontoCanada
  3. 3.Department of Medicine, Department of RadiologyUniversity Health NetworkTorontoCanada
  4. 4.Division of RheumatologyUniversity Health NetworkTorontoCanada

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