New Guidelines Advocate ILD Screening for Systemic Sclerosis Patients

​Updated ⁤June 15, 2025

Barcelona, Spain—The European Alliance of Associations for Rheumatology (EULAR) 2025 Annual Meeting featured new guidelines recommending that all patients with systemic sclerosis (SSc) and mixed connective ​tissue disease (MCTD) ‍undergo screening for interstitial lung disease (ILD). These guidelines,a ⁣joint effort by EULAR and the⁣ European Respiratory Society (ERS),offer⁤ comprehensive recommendations for ⁣screening,diagnosis,and management of ILD across various connective tissue ⁣diseases (CTDs).

The CTDs include SSc, MCTD, rheumatoid arthritis (RA), idiopathic inflammatory myopathies (IIM), and Sjögren’s disease (sjd). Dr. Bernhard Hellmich,⁢ University ⁤of Tübingen, Germany, who moderated⁣ the session, emphasized the interdisciplinary nature ⁤of the guidelines, noting that they represent the first such collaboration between rheumatologists and pulmonologists in Europe.

The guidelines⁣ highlight the importance of systematic screening for interstitial lung disease with high-resolution computed tomography (HRCT) in‌ all SSc and MCTD patients, irrespective of risk factors. This suggestion extends too IIM patients, excluding those with inclusion body myositis.For RA, SjD, and⁢ other CTDs, the‍ guidelines advise assessing disease-specific risk factors ​before considering HRCT screening. The new guidelines for interstitial lung disease (ILD) screening mark ‌a notable step forward in patient care.

Anna-Maria ‍Hoffmann-Vold, MD, PhD, Oslo University Hospital, Norway, who ‌presented the guidelines, noted the absence of specific recommendations regarding screening frequency due to limited evidence. She suggested using the ‌initial diagnostic approach and monitoring for new risk factors for ILD ​progression.Re-screening is advised for patients with⁤ additional red flags, such as⁣ persistent joint disease in RA, or any suspicion of disease progression.

The guidelines strongly discourage using pulmonary function tests or lung ultrasound as primary screening tools for ILD, though forced vital capacity and diffusing capacity tests can supplement⁣ evaluations when ‌symptoms or CT abnormalities are present.

Monitoring Interstitial Lung Disease ⁤Progression

Following diagnosis, the guidelines provide‌ specific timeframes for monitoring ILD progression, stratified⁣ by disease and risk level. Clinicians should assess the risk of ILD progression within the following year, considering prior lung⁤ function tests, HRCT results, the 6-minute walking test, and​ risk factors such as disease-specific markers, disease activity, and HRCT patterns.

Hoffmann-Vold explained that patients can be categorized as higher‌ or lower risk based on these factors, along with‍ disease duration, to determine appropriate monitoring ​intervals. For⁣ high-risk patients with any CTD,lung function tests ‍should occur every 3-6 months initially,then every 6-12⁣ months. Lower-risk patients should undergo‌ lung‍ tests every 6-12 months initially, followed by annual testing.

Interstitial Lung​ disease Treatment Recommendations

The new treatment recommendations‍ offer tailored options⁣ for each disease,‌ guiding clinicians in ‌selecting the most suitable⁣ medication for individual patients, according to Hoffmann-Vold. The guidelines strongly⁤ recommend tocilizumab ⁤for SSc-ILD patients ​with early diffuse SSc and inflammation signs. For IIM-ILD⁣ patients, immunosuppressive ​treatment, including glucocorticoids, calcineurin inhibitors, rituximab, mycophenolate, or ‌azathioprine, is advised.

Other treatment recommendations are conditional due