Screening and Monitoring Chapter 1: Why Guidelines Exist

Watch Chapter 2 here.

Hello, and welcome back to the ILD Explainer Video Series. I am Dr Elana Bernstein, an associate professor of medicine at Columbia University Vagelos College of Physicians & Surgeons and an associate attending at New York-Presbyterian Hospital. I am also the founder and director of the Columbia University/New York-Presbyterian Scleroderma Program. 

This series focuses on screening and monitoring ILDs. In this video, we’ll simplify the 2023 American College of Rheumatology—known as ACR—and the American College of Chest Physicians—known as CHEST— recommendations into practical clinic tools, outline disease-specific screening intervals and monitoring thresholds, demonstrate what progression looks like on tests and imaging, and share workflow strategies to embed these guidelines into daily practice. 

In our first video, Maria presented with subtle pulmonary symptoms that raised suspicion of ILD. Today, we’ll pick up where Maria’s story left off to highlight, upon ILD diagnosis, how often to monitor for progression. We’ll also walk through how to define progression and how to embed these guidelines into daily practice.

The 2023 ACR and CHEST guidelines provide the most current, evidence-based recommendations for screening and monitoring ILD in systemic autoimmune rheumatic diseases (SARDs). 

These guidelines aim to close gaps in care by providing clear direction on when patients with a SARD may be at high risk of ILD, when to screen, and how often to give tests to monitor for progression. 

In doing so, they translate complex evidence into practical steps that help clinicians detect ILD earlier, follow it more consistently, and guide monitoring with confidence. 

However, let’s acknowledge a common challenge: guidelines can feel overwhelming. Some clinicians may worry that guidelines are too complex or impractical to implement in a busy clinic. The reality is that guidelines are practical tools, roadmaps that simplify decision-making. 

In this video, I aim to help you confidently apply the 2023 ACR and CHEST guidelines to your clinic. 

Maria’s case illustrates how structured assessment and regular monitoring can change the disease trajectory, allowing us to intervene earlier and preserve lung function.  

The final step is to embed these recommendations into daily clinical workflow, whether through EMR prompts, standardized order sets, or routine checklists, so that screening, monitoring, and defining progression become second nature in practice. This way, we can translate guidelines into better outcomes for patients. 

For Maria and your patients, these steps can make all the difference. 

Guidelines are not obstacles—they are tools. Use them confidently, and you can change the course of ILD for your patients. 

6MWD – 6-minute walk distance 
ACR – American College of Rheumatology 
Architectural distortion – Irreversible displacement of normal lung structures due to fibrosis 
CHEST – American College of Chest Physicians 
CTD-ILD – Connective tissue disease–associated interstitial lung disease 
DLCO – Diffusing capacity of the lung for carbon monoxide 
EMR – Electronic medical record 
FVC – Forced vital capacity 
GGO – Ground-glass opacity 
HRCT – High-resolution computed tomography 
IIM – Idiopathic inflammatory myopathy 
ILD – Interstitial lung disease 
MCTD – Mixed connective tissue disease 
MDD – Multidisciplinary discussion 
NSIP – Nonspecific interstitial pneumonia 
OP – Organizing pneumonia 
PFT – Pulmonary function testing 
PPF – Progressive pulmonary fibrosis 
Progression (ILD) – Worsening physiologic, radiologic, or symptomatic disease over time 
RA – Rheumatoid arthritis 
Radiologic progression – Worsening fibrotic features on HRCT 
Reticulation – Network of fine linear opacities caused by septal thickening 
SARD – Systemic autoimmune rheumatic disease 
SjD – Sjögren disease 
SSc – Systemic sclerosis 
Traction bronchiectasis – Irreversible airway dilation due to fibrotic pulling 
UIP – Usual interstitial pneumonia 

Antoniou KM, Distler O, Gheorghiu AM, et al. ERS/EULAR clinical practice guidelines for connective tissue disease-associated interstitial lung disease developed by the task force for connective tissue disease-associated interstitial lung disease of the European Respiratory Society (ERS) and the European Alliance of Associations for Rheumatology (EULAR) endorsed by the European Reference Network on rare respiratory diseases (ERN-LUNG). Eur Respir J. Published online September 11, 2025. doi:10.1183/13993003.02533-2024 

Guiot J, Miedema J, Cordeiro A, et al. Practical guidance for the early recognition and follow-up of patients with connective tissue disease-related interstitial lung disease.  Autoimmun Rev. 2024;23(6):103582. doi:10.1016/j.autrev.2024.103582 

Johnson SR, Bernstein EJ, Bolster MB, et al. 2023 American College of Rheumatology (ACR)/American College of Chest Physicians (CHEST) guideline for the screening and monitoring of interstitial lung disease in people with systemic autoimmune rheumatic diseases.  Arthritis Rheumatol. 2024;76(8):1201-1213. doi:10.1002/art.42860 

Johnson SR, Bernstein EJ, Bolster MB, et al. 2023 American College of Rheumatology (ACR)/American College of Chest Physicians (CHEST) guideline for the treatment of interstitial lung disease in people with systemic autoimmune rheumatic diseases.  Arthritis Care Res (Hoboken). 2024;76(8):1051-1069. doi:10.1002/acr.25348 

Montolio-Chiva L, Carmona-Talavera D, López-Ortega JM, Orenes-Vera AV, Flores-Fernández E, Alegre-Sancho JJ. Coexistence of anti-topoisomerase I and anticentromere antibodies in a patient with systemic sclerosis. Efficacy of treatment combining rituximab and nintedanib. A case report.  Int J Immunopathol Pharmacol. 2022;36:3946320221115310. doi:10.1177/03946320221115310 

Ponce MC, Sankari A, Sharma S. Pulmonary function tests. StatPearls [Internet]. StatPearls Publishing; 2025. Accessed November 13, 2025. https://www.ncbi.nlm.nih.gov/books/NBK482339/ 

Wong AW, Ryerson CJ, Guler SA. Progression of fibrosing interstitial lung disease.  Respir Res. 2020;21(1):32. doi:10.1186/s12931-020-1296-3