Rheumatology and respiratory medicine highlighted at ISR

Working with multidisciplinary teams (MDTs) and keeping an open mind is important in managing both interstitial lung diseases (ILD) and rheumatic diseases, the ISR 2022 Spring Meeting heard. 

Dr Kate O’Reilly, Consultant in Respiratory and Acute Medicine at the Mater Misericordiae University Hospital, Dublin, told the Medical Independent that working with MDTs helps to break a fixed view of a patient or disease that a physician may have. 

“It’s really the multidisciplinary team: Respiratory physicians, rheumatologists, radiologists working together and being willing to reanalyse the data and change direction, rather than having a fixed view that this is the diagnosis and this is our strategy,” she said. 

“In some diseases, there are very clear diagnostic criteria. But with [ILD], it’s much woollier really,” she said in her presentation. 

In her talk on ILD in rheumatic diseases, Dr O’Reilly told ISR delegates that MDTs and discussion “is key” and even “critical” in complex patients. While there may be criteria available to diagnose a rheumatic disease, “[criteria] can change in flux and there could be differences of opinion. So, it’s really important to have a team together and a team that are used to looking at these patients.” 

ILDs are a complex and large category of lung diseases, the main ones being: Those with a known aetiology such as drug use or occupational exposures; granulomatous or inflammatory ILDs such as hypersensitivity pneumonia; or idiopathic interstitial pneumonias such as idiopathic pulmonary fibrosis. They can also be frequently associated with rheumatological diseases. 

“Just because we’re sitting at MDT talking about somebody who’s got an ILD, it doesn’t mean that even if they don’t have a rheumatologic diagnosis now, that they won’t have one,” said Dr O’Reilly. 

“You all manage lots of patients with rheumatoid arthritis,” she told the audience. “And those patients get an awful lot of airways disease.” 

Pulmonary functional tests (PFTs) can assess for progressive disease, including: Spirometry, looking for obstructive or restrictive patterns; assessing lung volume and capacity; and diffusion capacity, looking at the integrity of the alveolar-capillary membrane. 

“PFTs are extremely useful in evaluating a patient with dyspnoea,” Dr O’Reilly said. “They’re very helpful in following… that patient over time, but they’re not sensitive when picking up early disease. Overall… they should be done at the time of diagnosis.” 

Radiology is also “a key aspect” in managing these patients with rheumatological diseases, she noted.

Irish Society for Rheumatology, Spring Meeting, Sligo Park Hotel, 19-20 May 2022.