Multidisciplinary Evaluation of Interstitial Lung Diseases: New Opportunities Linked to Rheumatologist Involvement
Multidisciplinary team (MDT) discussion is the gold standard in the management of interstitial lung disease (ILD). The rheumatologist is not routinely involved in MDT, even if up to 20% of ILD are related to systemic autoimmune rheumatic diseases (SARD). The study aims to assess the agreement and it...
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| Veröffentlicht in: | Diagnostics (Basel) 2020-09, Vol.10 (9), p.664, Article 664 |
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| creator | De Lorenzis, Enrico Bosello, Silvia Laura Varone, Francesco Sgalla, Giacomo Calandriello, Lucio Natalello, Gerlando Iovene, Bruno Cicchetti, Giuseppe Gigante, Laura Verardi, Lucrezia Gremese, Elisa Richeldi, Luca Larici, Anna Rita |
| description | Multidisciplinary team (MDT) discussion is the gold standard in the management of interstitial lung disease (ILD). The rheumatologist is not routinely involved in MDT, even if up to 20% of ILD are related to systemic autoimmune rheumatic diseases (SARD). The study aims to assess the agreement and its variation over time between rheumatologists and pulmonologists in the screening of SARD and between rheumatologists and an MDT extended to rheumatologists (eMDT) in evaluating the progression of SARD. We computed the agreement between the pulmonologist and rheumatologist in the identification of red flags for SARDs of 81 ILD cases and between the rheumatologist alone and eMDT in the confirmation of 70 suspected SARD-ILD progressions. The agreement between rheumatologists and pulmonologists was moderate for the detection of autoimmunity test positivity (kappa = 0.475, p < 0.001) and family history of SARD (kappa = 0.491, p < 0.001) and fair for the identification of extrapulmonary symptoms (kappa = 0.225, p = 0.064) or routine laboratory abnormalities consistent with SARD. The average agreement between the rheumatologist and eMDT in the identification of ILD progression was moderate (kappa = 0.436, p < 0.001). The class of agreement improved from the first to the third semester. The average agreement with the rheumatologist ranged from fair to moderate, suggesting that a shared evaluation of SARD-ILD in eMDT could improve the diagnostic work-up and the evaluation of ILD progression. |
| doi_str_mv | 10.3390/diagnostics10090664 |
| format | Article |
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The rheumatologist is not routinely involved in MDT, even if up to 20% of ILD are related to systemic autoimmune rheumatic diseases (SARD). The study aims to assess the agreement and its variation over time between rheumatologists and pulmonologists in the screening of SARD and between rheumatologists and an MDT extended to rheumatologists (eMDT) in evaluating the progression of SARD. We computed the agreement between the pulmonologist and rheumatologist in the identification of red flags for SARDs of 81 ILD cases and between the rheumatologist alone and eMDT in the confirmation of 70 suspected SARD-ILD progressions. The agreement between rheumatologists and pulmonologists was moderate for the detection of autoimmunity test positivity (kappa = 0.475, p < 0.001) and family history of SARD (kappa = 0.491, p < 0.001) and fair for the identification of extrapulmonary symptoms (kappa = 0.225, p = 0.064) or routine laboratory abnormalities consistent with SARD. The average agreement between the rheumatologist and eMDT in the identification of ILD progression was moderate (kappa = 0.436, p < 0.001). The class of agreement improved from the first to the third semester. The average agreement with the rheumatologist ranged from fair to moderate, suggesting that a shared evaluation of SARD-ILD in eMDT could improve the diagnostic work-up and the evaluation of ILD progression.</description><identifier>ISSN: 2075-4418</identifier><identifier>EISSN: 2075-4418</identifier><identifier>DOI: 10.3390/diagnostics10090664</identifier><identifier>PMID: 32887318</identifier><language>eng</language><publisher>BASEL: Mdpi</publisher><subject>Biopsy ; Comorbidity ; connective tissue disease ; Disease ; Family medical history ; Flags ; General & Internal Medicine ; Identification ; interstitial lung disease ; interstitial pneumonia with autoimmune features ; Laboratories ; Life Sciences & Biomedicine ; Medicine, General & Internal ; Meetings ; multidisciplinary team ; Pneumonia ; rheumatoid arthritis ; Rheumatology ; Science & Technology ; systemic rheumatic autoimmune disease</subject><ispartof>Diagnostics (Basel), 2020-09, Vol.10 (9), p.664, Article 664</ispartof><rights>2020. This work is licensed under http://creativecommons.org/licenses/by/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 by the authors. 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>15</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000581375700001</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c476t-767d6442caed6c1f93913f4140d66abdf0ab01003599212c245a04c2443203823</citedby><cites>FETCH-LOGICAL-c476t-767d6442caed6c1f93913f4140d66abdf0ab01003599212c245a04c2443203823</cites><orcidid>0000-0002-2248-1058 ; 0000-0001-9819-105X ; 0000-0001-7333-371X ; 0000-0002-6381-1850 ; 0000-0001-8594-1448 ; 0000-0001-8714-3124 ; 0000-0001-5953-3440 ; 0000-0003-1658-6694</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554734/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554734/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,728,781,785,865,886,2103,2115,27929,27930,28253,53796,53798</link.rule.ids></links><search><creatorcontrib>De Lorenzis, Enrico</creatorcontrib><creatorcontrib>Bosello, Silvia Laura</creatorcontrib><creatorcontrib>Varone, Francesco</creatorcontrib><creatorcontrib>Sgalla, Giacomo</creatorcontrib><creatorcontrib>Calandriello, Lucio</creatorcontrib><creatorcontrib>Natalello, Gerlando</creatorcontrib><creatorcontrib>Iovene, Bruno</creatorcontrib><creatorcontrib>Cicchetti, Giuseppe</creatorcontrib><creatorcontrib>Gigante, Laura</creatorcontrib><creatorcontrib>Verardi, Lucrezia</creatorcontrib><creatorcontrib>Gremese, Elisa</creatorcontrib><creatorcontrib>Richeldi, Luca</creatorcontrib><creatorcontrib>Larici, Anna Rita</creatorcontrib><title>Multidisciplinary Evaluation of Interstitial Lung Diseases: New Opportunities Linked to Rheumatologist Involvement</title><title>Diagnostics (Basel)</title><addtitle>DIAGNOSTICS</addtitle><description>Multidisciplinary team (MDT) discussion is the gold standard in the management of interstitial lung disease (ILD). The rheumatologist is not routinely involved in MDT, even if up to 20% of ILD are related to systemic autoimmune rheumatic diseases (SARD). The study aims to assess the agreement and its variation over time between rheumatologists and pulmonologists in the screening of SARD and between rheumatologists and an MDT extended to rheumatologists (eMDT) in evaluating the progression of SARD. We computed the agreement between the pulmonologist and rheumatologist in the identification of red flags for SARDs of 81 ILD cases and between the rheumatologist alone and eMDT in the confirmation of 70 suspected SARD-ILD progressions. The agreement between rheumatologists and pulmonologists was moderate for the detection of autoimmunity test positivity (kappa = 0.475, p < 0.001) and family history of SARD (kappa = 0.491, p < 0.001) and fair for the identification of extrapulmonary symptoms (kappa = 0.225, p = 0.064) or routine laboratory abnormalities consistent with SARD. The average agreement between the rheumatologist and eMDT in the identification of ILD progression was moderate (kappa = 0.436, p < 0.001). The class of agreement improved from the first to the third semester. The average agreement with the rheumatologist ranged from fair to moderate, suggesting that a shared evaluation of SARD-ILD in eMDT could improve the diagnostic work-up and the evaluation of ILD progression.</description><subject>Biopsy</subject><subject>Comorbidity</subject><subject>connective tissue disease</subject><subject>Disease</subject><subject>Family medical history</subject><subject>Flags</subject><subject>General & Internal Medicine</subject><subject>Identification</subject><subject>interstitial lung disease</subject><subject>interstitial pneumonia with autoimmune features</subject><subject>Laboratories</subject><subject>Life Sciences & Biomedicine</subject><subject>Medicine, General & Internal</subject><subject>Meetings</subject><subject>multidisciplinary team</subject><subject>Pneumonia</subject><subject>rheumatoid arthritis</subject><subject>Rheumatology</subject><subject>Science & Technology</subject><subject>systemic rheumatic autoimmune disease</subject><issn>2075-4418</issn><issn>2075-4418</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><sourceid>DOA</sourceid><recordid>eNqNksFuEzEQhlcIRKvSJ-CyEhckFLDXY-8uBySUFogUqITgbDne2dTBsYPtTcXbM02qiiIO-DKW_c3vmfFfVc85ey1Ez94MzqxDzMXZzBnrmVLwqDptWCtnALx7_Mf-pDrPecNo9Vx0jXxanYim61rBu9MqfZ58cYPL1u28Cyb9qi_3xk-muBjqONaLUDDRO8UZXy-nsK4vXEaTMb-tv-BNfbXbxVSmQADmeunCDxzqEuuv1zhtTYk-rl0uJLOPfo9bDOVZ9WQ0PuP5XTyrvn-4_Db_NFtefVzM3y9nFlpVZq1qBwXQWIODsnzsBZU_Agc2KGVWw8jMilHvQvZ9wxvbgDQMKIBoGPUpzqrFUXeIZqN3yW2pOx2N04eDmNbaJBqgR21bBUwItDAYQAUrLmDsTIdilDAaJK13R63dtNriYKmNZPwD0Yc3wV3rddzrVkpoBZDAyzuBFH9OmIve0szRexMwTllT2QyUBOgJffEXuolTCjSqAyV5QxhR4kjZFHNOON4Xw5m-tYj-h0Uo69Ux6wZXcaRPx2DxPpMsIjsuWtneuoUT3f0_PXflYJp5nEIRvwHFD9MD</recordid><startdate>20200902</startdate><enddate>20200902</enddate><creator>De Lorenzis, Enrico</creator><creator>Bosello, Silvia Laura</creator><creator>Varone, Francesco</creator><creator>Sgalla, Giacomo</creator><creator>Calandriello, Lucio</creator><creator>Natalello, Gerlando</creator><creator>Iovene, Bruno</creator><creator>Cicchetti, Giuseppe</creator><creator>Gigante, Laura</creator><creator>Verardi, Lucrezia</creator><creator>Gremese, Elisa</creator><creator>Richeldi, Luca</creator><creator>Larici, Anna Rita</creator><general>Mdpi</general><general>MDPI AG</general><general>MDPI</general><scope>AOWDO</scope><scope>BLEPL</scope><scope>DTL</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7XB</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-2248-1058</orcidid><orcidid>https://orcid.org/0000-0001-9819-105X</orcidid><orcidid>https://orcid.org/0000-0001-7333-371X</orcidid><orcidid>https://orcid.org/0000-0002-6381-1850</orcidid><orcidid>https://orcid.org/0000-0001-8594-1448</orcidid><orcidid>https://orcid.org/0000-0001-8714-3124</orcidid><orcidid>https://orcid.org/0000-0001-5953-3440</orcidid><orcidid>https://orcid.org/0000-0003-1658-6694</orcidid></search><sort><creationdate>20200902</creationdate><title>Multidisciplinary Evaluation of Interstitial Lung Diseases: New Opportunities Linked to Rheumatologist Involvement</title><author>De Lorenzis, Enrico ; 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The rheumatologist is not routinely involved in MDT, even if up to 20% of ILD are related to systemic autoimmune rheumatic diseases (SARD). The study aims to assess the agreement and its variation over time between rheumatologists and pulmonologists in the screening of SARD and between rheumatologists and an MDT extended to rheumatologists (eMDT) in evaluating the progression of SARD. We computed the agreement between the pulmonologist and rheumatologist in the identification of red flags for SARDs of 81 ILD cases and between the rheumatologist alone and eMDT in the confirmation of 70 suspected SARD-ILD progressions. The agreement between rheumatologists and pulmonologists was moderate for the detection of autoimmunity test positivity (kappa = 0.475, p < 0.001) and family history of SARD (kappa = 0.491, p < 0.001) and fair for the identification of extrapulmonary symptoms (kappa = 0.225, p = 0.064) or routine laboratory abnormalities consistent with SARD. The average agreement between the rheumatologist and eMDT in the identification of ILD progression was moderate (kappa = 0.436, p < 0.001). The class of agreement improved from the first to the third semester. 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| subjects | Biopsy Comorbidity connective tissue disease Disease Family medical history Flags General & Internal Medicine Identification interstitial lung disease interstitial pneumonia with autoimmune features Laboratories Life Sciences & Biomedicine Medicine, General & Internal Meetings multidisciplinary team Pneumonia rheumatoid arthritis Rheumatology Science & Technology systemic rheumatic autoimmune disease |
| title | Multidisciplinary Evaluation of Interstitial Lung Diseases: New Opportunities Linked to Rheumatologist Involvement |
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