CHEST Guidelines-The-Clinical-Relevance-of-Infection-and-Its-Treatm

The-Clinical-Relevance-of-Infection-and-Its-Treatm

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The document contains discussions on treatment approaches for rapidly progressive interstitial lung disease (RP-ILD) associated with myositis and microscopic polyangiitis (MPA). The authors address the challenges of defining RP-ILD due to its similarity to acute respiratory distress syndrome (ARDS). There is an ongoing debate about the use of rituximab versus cyclophosphamide as first-line treatment for myositis-associated conditions, pointing to the RECITAL trial designed to determine the efficacy of these drugs. The use of intravenous immunoglobulins and early transplantation consideration are also highlighted, though the latter was not applicable in the discussed patient cases.<br /><br />Attention is drawn to improved outcomes with newer treatments for RP-ILD. However, past treatment shortcomings resulted from extended procedures due to early diagnostic challenges. Suggestions are made for ECMO usage in myositis-related RP-ILD as a recovery bridge or for transplantation.<br /><br />Further, the discussion shifts to a study by Hozumi et al. on clinical outcomes in MPA with or without ILD. The concern raised is the neglect of antibiotic therapies in their analysis, despite the known high infection risk in anti-neutrophil cytoplasmic antibody-associated vasculitis patients, which constitutes a significant mortality factor. The study's findings show a high death proportion from infections, emphasizing the importance of considering antibiotics in such assessments. The response to these concerns clarifies that infection risks and antibiotic use were comparable between different patient groups in the MPA study.<br /><br />Both articles stress the evolving understanding and management of ILD-related conditions, advocating for more tailored approaches considering patients' specific clinical scenarios and recognizing the significant factors leading to adverse outcomes.

Keywords

RP-ILD

myositis

microscopic polyangiitis

rituximab

cyclophosphamide

RECITAL trial

intravenous immunoglobulins

ECMO

antibiotic therapies

vasculitis