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Prognosis and treatment of interstitial lung disease in systemic sclerosis (scleroderma)

Author
John Varga, MD
Section Editors
Talmadge E King, Jr, MD
John S Axford, DSc, MD, FRCP, FRCPCH
Deputy Editor
Helen Hollingsworth, MD

INTRODUCTION

Interstitial lung disease (ILD) is a frequent complication of systemic sclerosis (SSc) that is often progressive and has a poor prognosis [1]. In a retrospective study of 619 patients with SSc, 40 percent of patients had a restrictive ventilatory defect (suggesting interstitial lung disease, ILD) either alone or in combination with pulmonary arterial hypertension [2]. Herein, we discuss the prognosis and treatment of SSc-associated ILD.

The clinical presentation and diagnosis of SSc lung disease and the treatment of SSc and SSc-associated pulmonary arterial hypertension are discussed separately. (See "Clinical manifestations, evaluation, and diagnosis of interstitial lung disease in systemic sclerosis (scleroderma)" and "Overview of pulmonary complications of systemic sclerosis (scleroderma)" and "Overview of the treatment and prognosis of systemic sclerosis (scleroderma) in adults" and "Pulmonary arterial hypertension in systemic sclerosis (scleroderma): Definition, classification, risk factors, screening, and prognosis".)

DEFINITIONS

The term ILD is broadly used to describe a heterogeneous group of disorders that are classified together because of similar clinical, radiographic, physiologic, or pathologic manifestations.

In the vast majority of patients with SSc-associated ILD, the lung injury is characterized by a pattern termed nonspecific interstitial pneumonia (NSIP) [3]. Histopathologically, NSIP is characterized by varying degrees of pulmonary inflammation and fibrosis, with some forms being primarily inflammatory (cellular NSIP) and others primarily fibrotic (fibrotic NSIP). Most investigators believe that cellular NSIP is the early stage of fibrotic NSIP. Although NSIP may have significant fibrosis, it is usually of uniform temporality. Fibroblastic foci and honeycombing, if present, are rare. (See "Idiopathic interstitial pneumonias: Clinical manifestations and pathology", section on 'Nonspecific interstitial pneumonia'.)

In a minority of patients with SSc-associated ILD, the histopathologic pattern is that of usual interstitial pneumonia (UIP). This pattern is characterized by a non-uniform distribution of alternating zones of dense fibrosis, fibroblast foci, scant inflammation, normal lung, and honeycomb change.

                           

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Literature review current through: Apr 2015. | This topic last updated: Mar 10, 2015.
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