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New Developments in Scleroderma Interstitial Lung Disease

Highland, Kristin Ba; Silver, Richard Mb

Current Opinion in Rheumatology: November 2005 - Volume 17 - Issue 6 - p 737-745
doi: 10.1097/01.bor.0000181534.67685.5a
Raynaud phenomenon, scleroderma, overlap syndromes and other fibrosing syndromes
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Purpose of review To review the recent medical literature pertaining to interstitial lung disease found in association with systemic sclerosis remains a major contributor to morbidity and mortality. Significant progress is being made in terms of understanding the pathogenesis, the best approaches to clinical evaluation, and various options for therapy of systemic sclerosis patients whose disease course is complicated by interstitial lung disease.

Recent findings Recent studies highlight the importance of microvascular disease, autoimmunity, and fibroblast differentiation/activation in the pathogenesis of systemic sclerosis-interstitial lung disease, particularly in the early phase of disease. It appears as if the balance between various pro-fibrotic/pro-inflammatory and anti-fibrotic/anti-inflammatory mediators may be central to interstitial lung disease pathogenesis, which presents potential opportunities for therapeutic intervention. The clinical approach to staging of disease activity remains controversial. High resolution computed tomography scans, bronchoalveolar lavage and various serum markers (e.g., surfactant protein D and KL-6) each may provide useful information about the degree of activity of the systemic sclerosis-interstitial lung disease. Currently, treatment recommendations are limited by a scarcity of well designed clinical trials, but the recently completed Scleroderma Lung Study is a model for future studies and is providing useful information about this important complication of systemic sclerosis.

Summary Basic and clinical studies of systemic sclerosis patients with interstitial lung disease are yielding promising data that ultimately will be translated in to more effective diagnostic and therapeutic strategies.

aAssistant Professor of Medicine, Division of Pulmonary, Critical Care, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, SC and bProfessor of Medicine and Pediatrics, Director, Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, SC

Correspondence to Kristin B Highland, MD Assistant Professor of Medicine Division of Pulmonary, Critical Care Allergy and Clinical Immunology 96 Jonathan Lucas Street, Suite 812 CSB Charleston, SC 29425, USA Tel: 843 792 2153; fax: 843 792 0732; e-mail: highlakb@musc.edu

Sponsorship: This study was supported in part by NIAMS grant P60 ARO 49459 and NHLBI grant U01 HL060750.

© 2005 Lippincott Williams & Wilkins, Inc.