New Guidelines for Screening ILD in Connective Tissue Diseases
At the recent European Alliance of Associations for Rheumatology (EULAR) Annual Meeting 2025 in Barcelona, new guidelines were released urging that all patients with systemic sclerosis (SSc) and mixed connective tissue disease (MCTD) undergo routine screening for interstitial lung disease (ILD). The recommendations, formed through collaboration between EULAR and the European Respiratory Society (ERS), signify a huge step towards integrated care in patients suffering from connective tissue diseases (CTDs).
Interdisciplinary Approach to Patient Care
These guidelines represent the first substantial recommendations on managing ILD crafted through collaboration between rheumatologists and pulmonologists. According to Bernhard Hellmich, MD, from the University of Tübingen, this interdisciplinary approach is vital. Previous ERS guidelines focused on ILD therapies alone but lacked an integrated perspective on screening and diagnosis across specialties. This innovation is expected to enhance early detection of ILD, potentially leading to better patient outcomes.
Essential Screening Recommendations
The recommendations stipulate that all patients diagnosed with SSc and MCTD should be screened for ILD using high-resolution computed tomography (HRCT), regardless of any existing risk factors. Moreover, patients with other CTDs such as rheumatoid arthritis (RA) and Sjögren's disease (SjD) should also undergo screening based on their specific risk factors. The strong emphasis on early detection through systematic screening could lead to improved treatment availability and better health trajectories long-term.
Guidelines for Monitoring Progression After Diagnosis
After ILD diagnosis, specific and time-sensitive monitoring strategies are outlined in the guidelines. These recommendations factor in various assessments including previous lung function tests and HRCT results to gauge the risk of ILD progression accurately. Patients exhibiting specific “red flags”—indicators of worsening health status—may require rescreening. This personalized approach tailors monitoring and interventions more effectively to each patient’s condition.
The Importance of HRCT Over Alternative Screening Approaches
Interestingly, the guidelines also caution against substituting HRCT with pulmonary function tests or lung ultrasound for initial screening. While these tests can provide valuable information about lung function during diagnosis, they are not as reliable for initial ILD screening as HRCT, which provides detailed images necessary for accurate diagnosis and management. This key differentiation is intended to ensure that patients receive the most effective care right from the start.
As healthcare continuously evolves, the emphasis placed on early detection and interdisciplinary cooperation sets a precedent that may greatly improve the quality of life for individuals battling ILD in the context of connective tissue diseases.
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