Identification and Diagnosis Chapter 1: Introduction

Watch Chapter 2 here.

Hello, and welcome to this program. 

In this session, we’ll discuss how to identify interstitial lung disease, or ILD, in patients with systemic autoimmune rheumatic disease, or SARD. These conditions include rheumatoid arthritis, systemic sclerosis, inflammatory myopathy or myositis, mixed connective tissue disease, and Sjögren disease. 

The goal today is to walk through the diagnostic pathway— pulmonary function testing, or PFTs, high-resolution computed tomography, or HRCT, and multidisciplinary discussion—and to show how this plays out in a patient scenario. 

To bring this to life, I want to introduce you to Maria. 

Maria is a 48-year-old woman with seropositive rheumatoid arthritis, or RA. Recently, she’s noticed something new: progressive exertional shortness of breath and a persistent dry cough. These symptoms have been present for several months. They’re nonspecific, and they haven’t gone away. 

Today, we’ll keep coming back to Maria as our guide. She represents many patients we see in the clinic—someone with well-controlled joint disease who suddenly develops respiratory symptoms. 

Let’s consider Maria’s case more closely. 

This is a scenario where rheumatology is often the first touchpoint. It raises the key question: how should we approach Maria’s case? 

We know that SARD accounts for roughly one-quarter of all ILD across multiple cohorts. That’s a big enough slice that every rheumatologist should consider lung involvement in routine care. 

Therefore, when Maria presents with unexplained breathlessness, even if her arthritis is well controlled or otherwise quiet, the index of suspicion for ILD has to be high. 

Let’s zoom out. 

ILD isn’t rare in autoimmune diseases — it’s common, under-recognized, and a major driver of morbidity and mortality.  In systemic sclerosis, more than half of patients will develop ILD, and it is the leading cause of mortality or death in this population. In RA, ILD is the second leading cause of death. 

Early identification can change the equation. Current therapies cannot reverse established fibrosis, but they can definitely slow progression. Additionally, getting a confident diagnosis early can spare patients the exposure to unnecessary or even harmful treatments.

For Maria, this means that her otherwise nonspecific cough and breathlessness should not be minimized. They should prompt an evaluation that looks specifically for ILD. 

Thank you for watching. 

We’ve followed Maria’s story from her first nonspecific symptoms through the red flags, risk stratification, diagnostic testing, and multidisciplinary review. 

Maria’s case illustrates the broader lesson: early suspicion, structured evaluation, and collaborative care make the difference. 

If you adopt this pathway in your clinic — screen, test, image, and discuss early — you’ll help patients like Maria avoid delays and receive the care they need. 

For more resources, please visit the Rheumatology and Arthritis Learning Network. 

6MWT – Six-minute walk test 
ANA – Antinuclear antibody 
Anti-CCP – Anti–cyclic citrullinated peptide antibody 
Anti-Ro52 – Anti-Ro/SSA autoantibody 
CTD-ILD – Connective tissue disease–associated interstitial lung disease 
DLCO – Diffusing capacity of the lungs for carbon monoxide 
FVC – Forced vital capacity 
GGO – Ground-glass opacity 
HRCT – High-resolution computed tomography 
IIM – Inflammatory idiopathic myopathy / inflammatory myositis 
ILD – Interstitial lung disease 
IPF – Idiopathic pulmonary fibrosis 
L – Liters 
LIP – Lymphocytic interstitial pneumonia 
MCTD – Mixed connective tissue disease 
MDD – Multidisciplinary discussion 
MDT – Multidisciplinary team 
NSIP – Nonspecific interstitial pneumonia 
OP – Organizing pneumonia 
PFT – Pulmonary function test 
PPF – Progressive pulmonary fibrosis 
RA – Rheumatoid arthritis 
RF – Rheumatoid factor 
SARD – Systemic autoimmune rheumatic disease 
SSc – Systemic sclerosis 
SS – Sjögren disease 
sec – Seconds 
UIP – Usual interstitial pneumonia 
VA – Alveolar volume 

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