DOI QR코드

DOI QR Code

Treatment of connective tissue disease-associated interstitial lung disease: the pulmonologist's point of view

  • Koo, So-My (Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soon Chun Hyang University Seoul Hospital) ;
  • Uh, Soo-Taek (Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soon Chun Hyang University Seoul Hospital)
  • Received : 2016.07.31
  • Accepted : 2017.06.16
  • Published : 2017.07.01

Abstract

Interstitial lung disease (ILD) occurs in 15% of patients with collagen vascular disease (CVD), referred to as connective tissue disease (CTD). Despite advances in management strategies, ILD continues to be a significant cause of mortality in patients with CVD-associated ILD (CTD-ILD). There is a lack of randomized, clinical trials assessing pharmacological agents for CTD-ILD, except in cases of ILD-associated systemic sclerosis (SSc). This may be due to the lack of CTD cases available, the difficulty of histological confirmation of ILD, and the various types of CTD and ILD. As a result, evidence-based pharmacological treatment of CTD-ILD is not yet well established. CTD-ILD presents with varying degrees of histology, from inflammation to fibrosis, and a wide spectrum of clinical manifestations, from minimal symptoms to respiratory failure. This renders it difficult for clinicians to make decisions regarding treatment options, observational strategies, optimal timing for interventions, and the appropriateness of pharmacological agents for treatment. There is no specific treatment for reversing fibrosis-like idiopathic pulmonary fibrosis in a clinical setting. This review describes pharmacological interventions for SSc-ILD described in randomized control trials, and presents an overview of recent advances of CTD-ILD-dependent treatments based on the types of CTD.

Keywords

Acknowledgement

Supported by : Soonchunhyang University

References

  1. Solomon JJ, Fischer A. Connective tissue disease-associated interstitial lung disease: a focused review. J Intensive Care Med 2015;30:392-400. https://doi.org/10.1177/0885066613516579
  2. Cottin V. Idiopathic interstitial pneumonias with connective tissue diseases features: a review. Respirology 2016;21:245-258. https://doi.org/10.1111/resp.12588
  3. Antoniou KM, Margaritopoulos G, Economidou F, Siafakas NM. Pivotal clinical dilemmas in collagen vascular diseases associated with interstitial lung involvement. Eur Respir J 2009;33:882-896. https://doi.org/10.1183/09031936.00152607
  4. Kowal-Bielecka O, Landewe R, Avouac J, et al. EULAR recommendations for the treatment of systemic sclerosis: a report from the EULAR Scleroderma Trials and Research group (EUSTAR). Ann Rheum Dis 2009;68:620-628. https://doi.org/10.1136/ard.2008.096677
  5. Saketkoo LA, Ascherman DP, Cottin V, Christopher-Stine L, Danoff SK, Oddis CV. Interstitial lung disease in idiopathic inflammatory myopathy. Curr Rheumatol Rev 2010;6:108-119. https://doi.org/10.2174/157339710791330740
  6. Assayag D, Ryerson CJ. Determining respiratory impairment in connective tissue disease-associated interstitial lung disease. Rheum Dis Clin North Am 2015;41:213-223. https://doi.org/10.1016/j.rdc.2014.12.003
  7. Mathai SC, Danoff SK. Management of interstitial lung disease associated with connective tissue disease. BMJ 2016;352:h6819.
  8. Ferri C, Manfredi A, Sebastiani M, et al. Interstitial pneumonia with autoimmune features and undifferentiated connective tissue disease: our interdisciplinary rheumatology-pneumology experience, and review of the literature. Autoimmun Rev 2016;15:61-70. https://doi.org/10.1016/j.autrev.2015.09.003
  9. Ryerson CJ, Collard HR. Update on the diagnosis and classification of ILD. Curr Opin Pulm Med 2013;19:453-459. https://doi.org/10.1097/MCP.0b013e328363f48d
  10. Kim KJ, Lee S, Kim WU. Applications of systems approaches in the study of rheumatic diseases. Korean J Intern Med 2015;30:148-160. https://doi.org/10.3904/kjim.2015.30.2.148
  11. Pereira DA, Dias OM, Almeida GE, et al. Lung-dominant connective tissue disease among patients with interstitial lung disease: prevalence, functional stability, and common extrathoracic features. J Bras Pneumol 2015;41:151-160. https://doi.org/10.1590/S1806-37132015000004443
  12. Fischer A, Lee JS, Cottin V. Interstitial lung disease evaluation: detecting connective tissue disease. Respiration 2015;90:177-184. https://doi.org/10.1159/000440665
  13. Kornum JB, Christensen S, Grijota M, et al. The incidence of interstitial lung disease 1995-2005: a Danish nationwide population-based study. BMC Pulm Med 2008;8:24. https://doi.org/10.1186/1471-2466-8-24
  14. Gabriel SE, Crowson CS, Kremers HM, et al. Survival in rheumatoid arthritis: a population-based analysis of trends over 40 years. Arthritis Rheum 2003;48:54-58. https://doi.org/10.1002/art.10705
  15. Sung YK, Cho SK, Choi CB, Bae SC. Prevalence and incidence of rheumatoid arthritis in South Korea. Rheumatol Int 2013;33:1525-1532. https://doi.org/10.1007/s00296-012-2590-2
  16. Arnett FC, Cho M, Chatterjee S, Aguilar MB, Reveille JD, Mayes MD. Familial occurrence frequencies and relative risks for systemic sclerosis (scleroderma) in three United States cohorts. Arthritis Rheum 2001;44:1359-1362. https://doi.org/10.1002/1529-0131(200106)44:6<1359::AID-ART228>3.0.CO;2-S
  17. Drosos AA, Andonopoulos AP, Costopoulos JS, Papadimitriou CS, Moutsopoulos HM. Prevalence of primary Sjogren's syndrome in an elderly population. Br J Rheumatol 1988;27:123-127. https://doi.org/10.1093/rheumatology/27.2.123
  18. Gaubitz M. Epidemiology of connective tissue disorders. Rheumatology (Oxford) 2006;45 Suppl 3:iii3-iii4. https://doi.org/10.1093/brheum/45.suppl_1.i3
  19. Ju JH, Yoon SH, Kang KY, et al. Prevalence of systemic lupus erythematosus in South Korea: an administrative database study. J Epidemiol 2014;24:295-303. https://doi.org/10.2188/jea.JE20120204
  20. Gunnarsson R, Molberg O, Gilboe IM, Gran JT; PAHNOR1 Study Group. The prevalence and incidence of mixed connective tissue disease: a national multicentre survey of Norwegian patients. Ann Rheum Dis 2011;70:1047-1051. https://doi.org/10.1136/ard.2010.143792
  21. Wallace B, Vummidi D, Khanna D. Management of connective tissue diseases associated interstitial lung disease: a review of the published literature. Curr Opin Rheumatol 2016;28:236-245. https://doi.org/10.1097/BOR.0000000000000270
  22. Bongartz T, Nannini C, Medina-Velasquez YF, et al. Incidence and mortality of interstitial lung disease in rheumatoid arthritis: a population-based study. Arthritis Rheum 2010;62:1583-1591. https://doi.org/10.1002/art.27405
  23. Palm O, Garen T, Berge Enger T, et al. Clinical pulmonary involvement in primary Sjogren's syndrome: prevalence, quality of life and mortality: a retrospective study based on registry data. Rheumatology (Oxford) 2013;52:173-179. https://doi.org/10.1093/rheumatology/kes311
  24. Yazisiz V, Arslan G, Ozbudak IH, et al. Lung involvement in patients with primary Sjogren's syndrome: what are the predictors? Rheumatol Int 2010;30:1317-1324. https://doi.org/10.1007/s00296-009-1152-8
  25. Gunnarsson R, Aalokken TM, Molberg O, et al. Prevalence and severity of interstitial lung disease in mixed connective tissue disease: a nationwide, cross-sectional study. Ann Rheum Dis 2012;71:1966-1972. https://doi.org/10.1136/annrheumdis-2011-201253
  26. Kiely PD, Chua F. Interstitial lung disease in inflammatory myopathies: clinical phenotypes and prognosis. Curr Rheumatol Rep 2013;15:359. https://doi.org/10.1007/s11926-013-0359-6
  27. Selva-O'Callaghan A, Labrador-Horrillo M, Munoz-Gall X, et al. Polymyositis/dermatomyositis-associated lung disease: analysis of a series of 81 patients. Lupus 2005;14:534-542. https://doi.org/10.1191/0961203305lu2158oa
  28. Fathi M, Vikgren J, Boijsen M, et al. Interstitial lung disease in polymyositis and dermatomyositis: longitudinal evaluation by pulmonary function and radiology. Arthritis Rheum 2008;59:677-685. https://doi.org/10.1002/art.23571
  29. Fidler L, Keen KJ, Touma Z, Mittoo S. Impact of pulmonary disease on patient-reported outcomes and patient- performed functional testing in systemic lupus erythematosus. Lupus 2016;25:1004-1011. https://doi.org/10.1177/0961203316630818
  30. Doyle TJ, Hunninghake GM, Rosas IO. Subclinical interstitial lung disease: why you should care. Am J Respir Crit Care Med 2012;185:1147-1153. https://doi.org/10.1164/rccm.201108-1420PP
  31. Dawson JK, Fewins HE, Desmond J, Lynch MP, Graham DR. Fibrosing alveolitis in patients with rheumatoid arthritis as assessed by high resolution computed tomography, chest radiography, and pulmonary function tests. Thorax 2001;56:622-627. https://doi.org/10.1136/thorax.56.8.622
  32. Ortega-Hernandez OD, Shoenfeld Y. Mixed connective tissue disease: an overview of clinical manifestations, diagnosis and treatment. Best Pract Res Clin Rheumatol 2012;26:61-72. https://doi.org/10.1016/j.berh.2012.01.009
  33. Uffmann M, Kiener HP, Bankier AA, Baldt MM, Zontsich T, Herold CJ. Lung manifestation in asymptomatic patients with primary Sjogren syndrome: assessment with high resolution CT and pulmonary function tests. J Thorac Imaging 2001;16:282-289. https://doi.org/10.1097/00005382-200110000-00009
  34. Tashkin DP, Elashoff R, Clements PJ, et al. Cyclophosphamide versus placebo in scleroderma lung disease. N Engl J Med 2006;354:2655-2666. https://doi.org/10.1056/NEJMoa055120
  35. Nadashkevich O, Davis P, Fritzler M, Kovalenko W. A randomized unblinded trial of cyclophosphamide versus azathioprine in the treatment of systemic sclerosis. Clin Rheumatol 2006;25:205-212. https://doi.org/10.1007/s10067-005-1157-y
  36. Clements PJ, Tashkin D, Roth M, et al. The scleroderma lung study II (SLS II) shows that both oral cyclophosphamide (CYC) and mycophenolate mofitil (MMF) are efficacious in treating progressive interstitial lung disease (ILD) in patients with systemic sclerosis (SSc). Arthritis Rheumatol 2015;67(Suppl 10):abstr1075.
  37. Daoussis D, Liossis SN, Tsamandas AC, et al. Experience with rituximab in scleroderma: results from a 1-year, proof-of-principle study. Rheumatology (Oxford) 2010;49:271-280. https://doi.org/10.1093/rheumatology/kep093
  38. Hoyles RK, Ellis RW, Wellsbury J, et al. A multicenter, prospective, randomized, double-blind, placebo-controlled trial of corticosteroids and intravenous cyclophosphamide followed by oral azathioprine for the treatment of pulmonary fibrosis in scleroderma. Arthritis Rheum 2006;54:3962-3970. https://doi.org/10.1002/art.22204
  39. Tanaka Y. Current concepts in the management of rheumatoid arthritis. Korean J Intern Med 2016;31:210-218. https://doi.org/10.3904/kjim.2015.137
  40. Singh JA, Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol 2016;68:1-26.
  41. Assayag D, Lee JS, King TE Jr. Rheumatoid arthritis associated interstitial lung disease: a review. Medicina (B Aires) 2014;74:158-165.
  42. Marigliano B, Soriano A, Margiotta D, Vadacca M, Afeltra A. Lung involvement in connective tissue diseases: a comprehensive review and a focus on rheumatoid arthritis. Autoimmun Rev 2013;12:1076-1084. https://doi.org/10.1016/j.autrev.2013.05.001
  43. Emery P, Fleischmann R, Filipowicz-Sosnowska A, et al. The efficacy and safety of rituximab in patients with active rheumatoid arthritis despite methotrexate treatment: results of a phase IIB randomized, double-blind, placebo-controlled, dose-ranging trial. Arthritis Rheum 2006;54:1390-1400. https://doi.org/10.1002/art.21778
  44. Matteson EL, Bongartz T, Ryu JH, Crowson CS, Hartman TE, Dellaripa PF. Open-label, pilot study of the safety and clinical effects of rituximab in patients with rheumatoid arthritis-associated interstitial pneumonia. Open J Rheumatol Autoimmune Dis 2012;2:53-58. https://doi.org/10.4236/ojra.2012.23011
  45. Saketkoo LA, Espinoza LR. Experience of mycophenolate mofetil in 10 patients with autoimmune-related interstitial lung disease demonstrates promising effects. Am J Med Sci 2009;337:329-335. https://doi.org/10.1097/MAJ.0b013e31818d094b
  46. Fischer A, Brown KK, Du Bois RM, et al. Mycophenolate mofetil improves lung function in connective tissue disease-associated interstitial lung disease. J Rheumatol 2013;40:640-646. https://doi.org/10.3899/jrheum.121043
  47. Reina D, Roig Vilaseca D, Torrente-Segarra V, et al. Sjogren's syndrome-associated interstitial lung disease: a multicenter study. Reumatol Clin 2016;12:201-205. https://doi.org/10.1016/j.reuma.2015.09.003
  48. Parambil JG, Myers JL, Lindell RM, Matteson EL, Ryu JH. Interstitial lung disease in primary Sjogren syndrome. Chest 2006;130:1489-1495. https://doi.org/10.1378/chest.130.5.1489
  49. Ito I, Nagai S, Kitaichi M, et al. Pulmonary manifestations of primary Sjogren's syndrome: a clinical, radiologic, and pathologic study. Am J Respir Crit Care Med 2005;171:632-638. https://doi.org/10.1164/rccm.200403-417OC
  50. Deheinzelin D, Capelozzi VL, Kairalla RA, Barbas Filho JV, Saldiva PH, de Carvalho CR. Interstitial lung disease in primary Sjogren's syndrome: clinical-pathological evaluation and response to treatment. Am J Respir Crit Care Med 1996;154(3 Pt 1):794-799. https://doi.org/10.1164/ajrccm.154.3.8810621
  51. Devauchelle-Pensec V, Mariette X, Jousse-Joulin S, et al. Treatment of primary Sjogren syndrome with rituximab: a randomized trial. Ann Intern Med 2014;160:233-242.
  52. Gottenberg JE, Cinquetti G, Larroche C, et al. Efficacy of rituximab in systemic manifestations of primary Sjogren's syndrome: results in 78 patients of the AutoImmune and Rituximab registry. Ann Rheum Dis 2013;72:1026-1031. https://doi.org/10.1136/annrheumdis-2012-202293
  53. Seror R, Sordet C, Guillevin L, et al. Tolerance and efficacy of rituximab and changes in serum B cell biomarkers in patients with systemic complications of primary Sjogren's syndrome. Ann Rheum Dis 2007;66:351-357. https://doi.org/10.1136/ard.2006.057919
  54. Lundberg IE. The prognosis of mixed connective tissue disease. Rheum Dis Clin North Am 2005;31:535-547. https://doi.org/10.1016/j.rdc.2005.04.005
  55. Burdt MA, Hoffman RW, Deutscher SL, Wang GS, Johnson JC, Sharp GC. Long-term outcome in mixed connective tissue disease: longitudinal clinical and serologic findings. Arthritis Rheum 1999;42:899-909. https://doi.org/10.1002/1529-0131(199905)42:5<899::AID-ANR8>3.0.CO;2-L
  56. Yamasaki Y, Yamada H, Yamasaki M, et al. Intravenous cyclophosphamide therapy for progressive interstitial pneumonia in patients with polymyositis/dermatomyositis. Rheumatology (Oxford) 2007;46:124-130. https://doi.org/10.1093/rheumatology/kel112
  57. Mira-Avendano IC, Parambil JG, Yadav R, et al. A retrospective review of clinical features and treatment outcomes in steroid-resistant interstitial lung disease from polymyositis/dermatomyositis. Respir Med 2013;107:890-896. https://doi.org/10.1016/j.rmed.2013.02.015
  58. Ge Y, Peng Q, Zhang S, Zhou H, Lu X, Wang G. Cyclophosphamide treatment for idiopathic inflammatory myopathies and related interstitial lung disease: a systematic review. Clin Rheumatol 2015;34:99-105. https://doi.org/10.1007/s10067-014-2803-z
  59. Ingegnoli F, Lubatti C, Ingegnoli A, Boracchi P, Zeni S, Meroni PL. Interstitial lung disease outcomes by high-resolution computed tomography (HRCT) in Anti- Jo1 antibody-positive polymyositis patients: a single centre study and review of the literature. Autoimmun Rev 2012;11:335-340. https://doi.org/10.1016/j.autrev.2011.09.007
  60. Kameda H, Nagasawa H, Ogawa H, et al. Combination therapy with corticosteroids, cyclosporin A, and intravenous pulse cyclophosphamide for acute/subacute interstitial pneumonia in patients with dermatomyositis. J Rheumatol 2005;32:1719-1726.
  61. Lee CS, Chen TL, Tzen CY, et al. Idiopathic inflammatory myopathy with diffuse alveolar damage. Clin Rheumatol 2002;21:391-396. https://doi.org/10.1007/s100670200104
  62. Bertsias G, Ioannidis JP, Boletis J, et al. EULAR recommendations for the management of systemic lupus erythematosus: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis 2008;67:195-205. https://doi.org/10.1136/ard.2007.070367
  63. Matthay RA, Schwarz MI, Petty TL, et al. Pulmonary manifestations of systemic lupus erythematosus: review of twelve cases of acute lupus pneumonitis. Medicine (Baltimore) 1975;54:397-409. https://doi.org/10.1097/00005792-197509000-00003
  64. Mittoo S, Fell CD. Pulmonary manifestations of systemic lupus erythematosus. Semin Respir Crit Care Med 2014;35:249-254. https://doi.org/10.1055/s-0034-1371537
  65. Weinrib L, Sharma OP, Quismorio FP Jr. A long-term study of interstitial lung disease in systemic lupus erythematosus. Semin Arthritis Rheum 1990;20:48-56. https://doi.org/10.1016/0049-0172(90)90094-V
  66. Spagnolo P, Cordier JF, Cottin V. Connective tissue diseases, multimorbidity and the ageing lung. Eur Respir J 2016;47:1535-1558. https://doi.org/10.1183/13993003.00829-2015
  67. Khanna D, Mittoo S, Aggarwal R, et al. Connective tissue disease-associated interstitial lung diseases (CTD-ILD): report from OMERACT CTD-ILD working group. J Rheumatol 2015;42:2168-2171. https://doi.org/10.3899/jrheum.141182
  68. Goh NS, Desai SR, Veeraraghavan S, et al. Interstitial lung disease in systemic sclerosis: a simple staging system. Am J Respir Crit Care Med 2008;177:1248-1254. https://doi.org/10.1164/rccm.200706-877OC
  69. Roth MD, Tseng CH, Clements PJ, et al. Predicting treatment outcomes and responder subsets in scleroderma-related interstitial lung disease. Arthritis Rheum 2011;63:2797-2808. https://doi.org/10.1002/art.30438
  70. Kurita T, Yasuda S, Amengual O, Atsumi T. The efficacy of calcineurin inhibitors for the treatment of interstitial lung disease associated with polymyositis/dermatomyositis. Lupus 2015;24:3-9. https://doi.org/10.1177/0961203314554849
  71. Khanna D, Saggar R, Mayes MD, et al. A one-year, phase I/IIa, open-label pilot trial of imatinib mesylate in the treatment of systemic sclerosis-associated active interstitial lung disease. Arthritis Rheum 2011;63:3540-3546. https://doi.org/10.1002/art.30548
  72. Spiera RF, Gordon JK, Mersten JN, et al. Imatinib mesylate (Gleevec) in the treatment of diffuse cutaneous systemic sclerosis: results of a 1-year, phase IIa, single-arm, open-label clinical trial. Ann Rheum Dis 2011;70:1003-1009. https://doi.org/10.1136/ard.2010.143974
  73. Horai Y, Miyamura T, Shimada K, et al. Eternacept for the treatment of patients with rheumatoid arthritis and concurrent interstitial lung disease. J Clin Pharm Ther 2012;37:117-121. https://doi.org/10.1111/j.1365-2710.2010.01234.x
  74. Perez-Alvarez R, Perez-de-Lis M, Diaz-Lagares C, et al. Interstitial lung disease induced or exacerbated by TNF-targeted therapies: analysis of 122 cases. Semin Arthritis Rheum 2011;41:256-264. https://doi.org/10.1016/j.semarthrit.2010.11.002
  75. Koo BS, Hong S, Kim YJ, Kim YG, Lee CK, Yoo B. Mortality in patients with rheumatoid arthritis-associated interstitial lung disease treated with an anti-tumor necrosis factor agent. Korean J Intern Med 2015;30:104-109. https://doi.org/10.3904/kjim.2015.30.1.104
  76. Mera-Varela A, Perez-Pampin E. Abatacept therapy in rheumatoid arthritis with interstitial lung disease. J Clin Rheumatol 2014;20:445-446. https://doi.org/10.1097/RHU.0000000000000084
  77. Mohr M, Jacobi AM. Interstitial lung disease in rheumatoid arthritis: response to IL-6R blockade. Scand J Rheumatol 2011;40:400-401. https://doi.org/10.3109/03009742.2011.599072
  78. Miura Y, Saito T, Fujita K, et al. Clinical experience with pirfenidone in five patients with scleroderma-related interstitial lung disease. Sarcoidosis Vasc Diffuse Lung Dis 2014;31:235-238.
  79. Mauhin W, Riviere S, Cabane J, Tiev KP. Improvement in lung fibrosis using intravenous immunoglobulin in systemic sclerosis with myositis. Scand J Rheumatol 2014;43:170-171. https://doi.org/10.3109/03009742.2013.868510
  80. van Laar JM, Farge D, Sont JK, et al. Autologous hematopoietic stem cell transplantation vs intravenous pulse cyclophosphamide in diffuse cutaneous systemic sclerosis: a randomized clinical trial. JAMA 2014;311:2490-2498. https://doi.org/10.1001/jama.2014.6368
  81. Cappelli S, Bellando Randone S, Camiciottoli G, De Paulis A, Guiducci S, Matucci-Cerinic M. Interstitial lung disease in systemic sclerosis: where do we stand? Eur Respir Rev 2015;24:411-419. https://doi.org/10.1183/16000617.00002915
  82. Solomon JJ, Chartrand S, Fischer A. Current approach to connective tissue disease-associated interstitial lung disease. Curr Opin Pulm Med 2014;20:449-456. https://doi.org/10.1097/MCP.0000000000000081
  83. Christie JD, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: 29th adult lung and heart-lung transplant report-2012. J Heart Lung Transplant 2012;31:1073-1086. https://doi.org/10.1016/j.healun.2012.08.004
  84. Bernstein EJ, Peterson ER, Sell JL, et al. Survival of adults with systemic sclerosis following lung transplantation: a nationwide cohort study. Arthritis Rheumatol 2015;67:1314-1322. https://doi.org/10.1002/art.39021
  85. Fischer A, du Bois R. Interstitial lung disease in connective tissue disorders. Lancet 2012;380:689-698. https://doi.org/10.1016/S0140-6736(12)61079-4
  86. Raghu G, Rochwerg B, Zhang Y, et al. An official ATS/ERS/JRS/ALAT clinical practice guideline: treatment of idiopathic pulmonary fibrosis: an update of the 2011 clinical practice guideline. Am J Respir Crit Care Med 2015;192:e3-e19. https://doi.org/10.1164/rccm.201506-1063ST
  87. Fischer A, Richeldi L. Cross-disciplinary collaboration in connective tissue disease-related lung disease. Semin Respir Crit Care Med 2014;35:159-165. https://doi.org/10.1055/s-0034-1371530

Cited by

  1. Connective Tissue Related Interstitial Lung Disease vol.7, pp.4, 2017, https://doi.org/10.1007/s13665-018-0212-5
  2. Iguratimod ameliorates bleomycin‐induced alveolar inflammation and pulmonary fibrosis in mice by suppressing expression of matrix metalloproteinase‐9 vol.22, pp.4, 2017, https://doi.org/10.1111/1756-185x.13463
  3. Comparison of anti-aminoacyl-tRNA synthetase antibody-related and idiopathic non-specific interstitial pneumonia vol.152, pp.None, 2019, https://doi.org/10.1016/j.rmed.2019.04.023
  4. Associations of Anti-Aquaporin 5 Autoantibodies with Serologic and Histopathological Features of Sjögren’s Syndrome vol.8, pp.11, 2019, https://doi.org/10.3390/jcm8111863
  5. Lung lesions in connective tissue diseases vol.29, pp.5, 2019, https://doi.org/10.18093/0869-0189-2019-29-5-604-611
  6. Comparative analysis of connective tissue disease-associated interstitial lung disease and interstitial pneumonia with autoimmune features vol.39, pp.2, 2017, https://doi.org/10.1007/s10067-019-04836-3
  7. Prevalence and Pattern of Pulmonary Manifestation in Patients with Connective Tissue Disorder vol.12, pp.4, 2017, https://doi.org/10.7759/cureus.7618
  8. A Real-World Experience of Mycophenolate Mofetil for Systemic Sclerosis: A Retrospective Multicenter Observational Study vol.35, pp.3, 2017, https://doi.org/10.46497/archrheumatol.2020.7771
  9. Efficacy and safety of rituximab in patients with chronic hypersensitivity pneumonitis (cHP): A retrospective, multicentric, observational study vol.172, pp.None, 2017, https://doi.org/10.1016/j.rmed.2020.106146
  10. Lupus and the Lungs: The Assessment and Management of Pulmonary Manifestations of Systemic Lupus Erythematosus vol.7, pp.None, 2017, https://doi.org/10.3389/fmed.2020.610257
  11. Interstitial Score and Concentrations of IL-4Rα, PAR-2, and MMP-7 in Bronchoalveolar Lavage Fluid Could Be Useful Markers for Distinguishing Idiopathic Interstitial Pneumonias vol.11, pp.4, 2021, https://doi.org/10.3390/diagnostics11040693