ILD

Need for better respiratory-rheumatology collaboration in ILD: experts


There is a pressing need for respiratory and rheumatology clinicians to work more effectively together in managing patients with interstitial lung disease (ILD), a multidisciplinary team of UK experts has urged.

Setting out their consensus statement, the group noted the growing need for cross-specialty collaboration as already happened in systemic sclerosis where ILD is seem most frequently but less so in other auto-immune ILDs.

Writing in Rheumatology, they said there needs to be better communication and shared learning between respiratory and rheumatology physicians, particularly where there are areas of controversy.

In addition, lung disease in rheumatoid arthritis is poorly understood “despite it being recognised as prevalent and important”, they add, with considerable impact on prognosis, survival and requiring consistent and effective management approaches.

A systematic approach is needed to optimise diagnosis, management and service provision for these patients, they concluded. It means multi-disciplinary teams should be widely incorporated into service specifications and consultant job plans rather than being irregular or convened ad-hoc.

Rheumatologists can play a key role in helping to diagnose and differentiate autoimmune ILD from other forms of ILD, an important and often challenging distinction that may shift the balance in favour of a trial of immunomodulatory therapy, they said.

But this collaboration is also critical for successful randomised clinical trials, generating a better evidence base and influencing policy development.

Lead author Dr Puja Mehta, a rheumatologist who also does research in respiratory disease at University College London, said models of working between the two specialities have been very variable but there was now more appetite and motivation to work together.

As an example of this she is presenting at both the British Society for Rheumatology and British Thoracic Society meetings this year.

“What was really nice is that we have a lot of authors from rheumatology and respiratory from tertiary centres as well as district general hospitals from all over the country coming together and making a consensus statement and really outlining the role that rheumatology can play which could be more active than it has been so far,” she told the limbic.

“That collaboration ultimately is to improve patient care and make sure that patients benefit from both specialists working together. To drive the field forward and progress, we really do need to to break down those silos and barriers and come together a bit more and a bit better than we have created previously.”

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