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Current
Rheumatology Reviews
ISSN: 1573-3971
Current Rheumatology Reviews
Volume 6, Number 2, May 2010
Contents
Editorial
Interstitial Lung Disease
with Connective Tissue Diseases Pp. 87
Guest Editor: Eric Matteson
Editorial
Pp. 88-90
The Idiopathic Interstitial Pneumonias and Connective Tissue
Disease-Associated Interstitial Lung Disease Pp.
91-98
Jeffrey J. Swigris, Kevin K. Brown and
Kevin R. Flaherty
[Abstract] [Purchase
Article]
Systemic Lupus Erythematosus-Related
Interstitial Lung Disease Pp. 99-107
Shikha Mittoo, Aryeh Fischer, Vibeke Strand, Richard Meehan
and Jeffrey J. Swigris
[Abstract] [Purchase
Article]
Interstitial Lung Disease in Idiopathic
Inflammatory Myopathy Pp. 108-119
Lesley Ann Saketkoo, Dana P. Ascherman, Vincent Cottin, Lisa
Christopher-Stine, Sonye K. Danoff and Chester V.
Oddis
[Abstract] [Purchase
Article]
Interstitial Lung Disease in Rheumatoid
Arthritis Pp. 120-126
Kristine Phillips, Kevin R. Flaherty, Eric L. Matteson, Tim
Bongartz, Joan Bathon, Kevin K. Brown and Paul F.
Dellaripa
[Abstract] [Purchase
Article]
Interstitial Lung Disease in Sjogren’s
Syndrome Pp. 127-137
Mandana Nikpour, Susanna M. Proudman, Nicole
S. Goh and Haralampos M. Moutsopoulos
[Abstract] [Purchase
Article]
Systemic Sclerosis-Associated Interstitial
Lung Disease: Lessons from Clinical Trials, Outcome Measures,
and Future Study Design Pp. 138-144
Dinesh Khanna, James R. Seibold, Athol Wells,
Oliver Distler, Yannick Allanore, Chris Denton and Daniel
E. Furst
[Abstract] [Purchase
Article]
Development of Clinical Trial Assessments
for the Study of Interstitial Lung Disease in Patients who
have Connective Tissue Diseases-Methodological Considerations
Pp. 145-150
Dörte Huscher, Lesley Ann Saketkoo, David
Pittrow and Dinesh Khanna on behalf of the CTD-ILD
Special Interest Group
[Abstract] [Purchase
Article]
General Article
Computer Assisted Surgery in Total Knee Arthroplasty Pp.
151-159
D. Tigani, R. Ben Ayad, G. Sabbioni, L. Amendola
and R. Fantasia
[Abstract] [Purchase
Article]
Abstracts
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Editorial: Introduction
from Editor-in-Chief
The issue of interstitial lung disease (ILD) often comes
up in the clinical practice of rheumatology. The etiology,
risk factors, exacerbating factors, and treatment of ILD in
the context of autoimmune diseases is the topic of this month's
Current Rheumatology Reports. As laid out by Dr. Matteson
in his editorial, research in this field is complicated by
the lack of standardized criteria for the diagnosis and the
lack of widely accepted outcome measurements. The international
CTD-ILD interest group is trying to address this problem by
developing standardized clinical trial assessments. In a thought
provoking piece in this issue of the journal, this group has
laid out their vision of how to achieve such a standardization.
Additionally, superb reviews on ILD in scleroderma, SLE, RA,
Sjogren's and myositis are presented here. The reader will
also find useful insights in the review of The idiopathic
interstitial pneumonias and CTD associated ILD by Swigris
and colleagues.
It has been our goal at the journal to provide a
forum for thought leaders to share their insights on the state
of their field of expertise. Indeed, we have achieved this
goal spectacularly in this issue of the journal.
Swamy Venuturupalli, M.D., F.A.C.R.
Asst. Clinical Prof. of Medicine-UCLA
Attending physician-Cedars Sinai Medical Center,
Los Angeles, CA
USA
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Article]
The Idiopathic Interstitial Pneumonias and Connective
Tissue Disease-Associated Interstitial Lung Disease
Jeffrey J. Swigris, Kevin K. Brown and
Kevin R. Flaherty
The idiopathic interstitial pneumonias (IIP) are seven fibro-inflammatory
interstitial lung diseases of unknown cause, grouped together
because of potentially similar clinical features. Each of
the seven has a distinct histologic pattern; however, these
patterns are not specific to the IIP, and they provide a framework
for defining interstitial lung disease (ILD) of known-cause,
including ILD associated with underlying connective tissue
disease (CTD). With the exception of respiratory bronchiolitis,
the histologic patterns corresponding with the other six IIP
can be found in association with CTD. Considering all CTD
together, the pattern of non-specific interstitial pneumonia
is most common. High-resolution computed tomography (HRCT)
can hint at the histologic pattern, track changes over time,
and assess response to therapy. The goal of this article is
to review histologic patterns and HRCT findings of the IIP
as they relate to CTD-associated ILD.
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Article]
Systemic Lupus Erythematosus-Related
Interstitial Lung Disease
Shikha Mittoo, Aryeh Fischer, Vibeke Strand, Richard Meehan
and Jeffrey J. Swigris
Systemic lupus erythematosus (SLE) is a systemic,
inflammatory disorder with a predilection for young women.
A wide array of pulmonary manifestations can occur in patients
with SLE, including interstitial lung disease. In this review,
we will discuss the scope, pathogenesis, management, and prognosis,
along with the clinical and pathologic features of SLE-associated
ILD (SLE-ILD).
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Article]
Interstitial Lung Disease in Idiopathic Inflammatory Myopathy
Lesley Ann Saketkoo, Dana P. Ascherman, Vincent Cottin, Lisa
Christopher-Stine, Sonye K. Danoff and Chester V.
Oddis
The lung is one of the most common extra-muscular
targets in idiopathic inflammatory myopathies (IIM) and interstitial
lung disease (ILD) is a prevalent and often devastating manifestation
of IIM. IIM-associated ILD (IIM-ILD) contributes to nearly
80% of the mortality in IIM with a reported prevalence of
65% of newly diagnosed IIM cases. Although ILD frequently
accompanies clinical and laboratory findings of myositis,
overt signs of muscle disease may be absent in the setting
of significant lung disease. Understanding the varied scope
of presentation of these diseases is essential to providing
optimal patient care. This review will provide an in depth
examination of ILD in IIM both from a rheumatologic and pulmonary
perspective and will discuss the scope of disease, presenting
features, genetic associations, pathogenesis, diagnosis, radiographic
and histopathologic findings, along with biomarker assessment
and a rationale for therapeutic intervention.
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Interstitial Lung Disease in Rheumatoid Arthritis
Kristine Phillips, Kevin R. Flaherty, Eric L. Matteson, Tim
Bongartz, Joan Bathon, Kevin K. Brown and Paul F.
Dellaripa
Rheumatoid arthritis (RA) affects 1-2% of the general
population. Although often thought of as primarily a localized
inflammatory disorder with associated joint destruction, it
is a diffuse systemic disease. Extra-articular manifestations
of rheumatoid arthritis can be demonstrated in almost 50%
of patients with RA, and include pulmonary, cardiac, ocular,
renal, hematologic, and neurologic involvement. In this article,
we review recent studies of interstitial lung disease (ILD)
in RA with a focus on clinical and pathological features of
rheumatoid arthritis associated interstitial lung disease
(RA-ILD). We discuss an approach to the diagnosis and treatment
of RA-ILD including potential biomarkers, and conclude by
outlining areas for future research.
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Interstitial Lung Disease in Sjogren’s Syndrome
Mandana Nikpour, Susanna M. Proudman, Nicole
S. Goh and Haralampos M. Moutsopoulos
Sjogren’s syndrome (SS), whether primary, or
secondary to other autoimmune rheumatic diseases, is classically
associated with the sicca complex of keratoconjunctivits and
xerostomia. However, extraglandular manifestations are also
relatively common, affecting up to 25% of patients. In this
article, we discuss respiratory system involvement in SS,
with a focus on interstitial lung disease (ILD). We review
the histopathologic variants, clinical features, diagnosis
and treatment of SS-ILD. Novel and emerging diagnostic and
prognostic biomarkers for SS-ILD are also discussed. We offer
an approach to the management of SS-ILD including possible
goals of therapy. We conclude by highlighting areas for future
research.
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[Purchase
Article]
Systemic Sclerosis-Associated Interstitial Lung Disease: Lessons
from Clinical Trials, Outcome Measures, and Future Study Design
Dinesh Khanna, James R. Seibold, Athol Wells,
Oliver Distler, Yannick Allanore, Chris Denton and Daniel
E. Furst
Pulmonary involvement including interstitial lung
disease (ILD) is the leading cause of mortality in patients
with systemic sclerosis (scleroderma; SSc). This article reviews
the current evidence based medicine regarding available therapies
for SSc-ILD; discusses the lessons learned from recent SSc-ILD
randomized controlled trials (RCTs); and proposes outcome
measures and recommendations for design of future RCTs for
SSc-ILD.
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Article]
Development of Clinical Trial Assessments for the Study of
Interstitial Lung Disease in Patients who have Connective
Tissue Diseases-Methodological Considerations
Dörte Huscher, Lesley Ann Saketkoo, David
Pittrow and Dinesh Khanna on behalf of the CTD-ILD
Special Interest Group
This review article discusses the proposed methodology
that will be utilized to develop core set items for connective
tissue disease-associated interstitial lung disease (CTD-ILD).
CTD-ILD remains an important enigma in clinical medicine.
No consensus exists on measurement of disease activity or
what constitutes a significant response to therapeutic interventions.
Lack of appropriate measures inhibit effective drug development
and hamper regulatory evaluation of candidate therapies.
An interdisciplinary and international Steering Committee
(SC) will oversee the execution of a 3-tier Delphi exercise
involving experts in CTD and ILD. In parallel to the Delphi,
qualitative information will be gathered from patients with
ILD using focus groups. These data will subsequently be used
to construct surveys to collect quantitative response from
patients with ILD.
The final Delphi and Patient Perspective results are to be
scrutinized by SC and specialty sub-groups (including patient
advocates) for truth, discrimination and feasibility - the
OMERACT filters. Through application of Nominal Group technique,
a core set of outcome measures will be proposed. Subsequent
exercises will evaluate the applicability of a proposed core
set to the unique issues posed by individual CTDs in addition
to guidelines on screening, prognostication and damage scoring.
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Article]
Computer Assisted Surgery in Total Knee Arthroplasty
D. Tigani, R. Ben Ayad, G. Sabbioni, L. Amendola
and R. Fantasia
Accuracy of implant positioning and precise reconstruction
of leg alignment offers the best way to achieve good long-term
results in total knee arthroplasty. Computer instrumentation
was developed to overcome the inherent limitations of mechanical
instrumentation, improving the final position of the component
and restoring the normal mechanical axis of the lower limb.
Current navigation systems use either optical or electromagnetic
tracking both having advantage and disadvantage. Knee navigation
systems are not yet universally accepted in the orthopedic
community, and their cost/benefit ratio remains a matter for
further discussion. Despite and high number of clinical trials
demonstrating that Computer-assisted navigation is a tool
which makes possible the accurate and reproducible performance
of a total knee procedure, we have to observe at the moment
an absence of high quality endpoint studies demonstrating
a longer implant survival in contraposition of standard technique.
The current methodology of tracker systems and the anatomical
referencing of the patient’s landmark are probably the
main sources of the limitation of the eventual systems. Finally
the cost/benefit ratio of the computer assisted technology
remains a matter of debate.
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