-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
-
Cosmetic Ingredient
- Water Treatment Chemical
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
*It is only for medical professionals to read.
How to manage lung disease in SS patients? Experts interpret the latest consensus.
This issue of "The Youth Committee of the Society of Rheumatology Takes You to ACR 2021" will be lectured by Dr.
Augustine Lee and Professor Nancy Carteron at the 2021 American Society of Rheumatology (ACR) Annual Conference, and will be interpreted by Professor Gao Jie from Shanghai Changhai Hospital.
"Guideline Interpretation: Consensus on Evaluation and Management of Sjögren’s Syndrome Pulmonary Disease
.
"
Dr.
Lee first introduced the guide
.
About one-sixth of patients with Sjogren’s syndrome (SS) have lung damage.
A consensus guideline on the assessment and management of SS lung disease was recently published (Figure 1), containing 52 practical recommendations
.
Figure 1 The pulmonary manifestations, diagnostic methods and management points of SS on the cover of the guide.
Common manifestations of lung disease in SS patients include: SS patients without respiratory symptoms; cough; interstitial lung disease (ILD); small nodules; consolidation; Cystic lung disease in SS patients
.
Let's first look at patients with SS who have no respiratory symptoms
.
Do such patients need to undergo imaging tests? The answer is yes.
It can be checked by rechecking symptoms (such as coughing and sputum, chest tightness, shortness of breath, etc.
), X-rays, and a full set of pulmonary function tests (PFT)
.
An average of 10% to 20%, and up to 65% of SS patients will have pulmonary complications, so screening is necessary
.
The full set of PFT refers to: spirometry: Is it obstructive? (FEV1, FVC); lung volume measurement: is it restricted? (TLC, TV); Diffusion capacity (DLCO): To assess the presence of lung parenchyma & pulmonary vascular abnormalities; Oxygen saturation: at rest & exercise
.
Evaluation of patients without respiratory symptoms SS shown in Figure 2: a flowchart of FIG.
2 Evaluation Note: CXR = chest X-ray; HRCT = thin CT As cough SS patients, including assessment of the PFT manner, chest CT and the like
.
Cough symptoms are also common in SS patients, and may reflect some serious abnormalities, such as ILD, tumors, etc.
, while CXR may have a missed diagnosis rate of 10% to 15%
.
The most likely cause of cough is dryness of the tracheal/bronchial mucosa.
Consider common causes including gastroesophageal reflux disease (GERD), rhinitis, and asthma
.
SS respiratory tract involvement includes three conditions, namely upper respiratory tract involvement, middle respiratory tract involvement, and lower respiratory tract involvement
.
Upper respiratory tract involvement, such as Sicca syndrome (salivary gland and lacrimal gland dysfunction), may have mouth, nose, and throat symptoms; middle respiratory tract involvement, such as tracheal/bronchial mucosa dryness, can easily cause coughing, with an incidence of 41%~61%; lower respiratory tract involvement It can be manifested as bronchiectasis, bronchiolitis, bronchial hyperresponsiveness/asthma, and the incidence of the three is 7%~54%, 12%~24% and 42%~60%, respectively
.
For SS patients with respiratory symptoms, the treatment process is shown in Figure 3: Figure 3 The treatment flow chart of SS patients with ILD accounted for about 25%, which are divided into 4 types: non-specific interstitial pneumonia (NSIP): 45%; ordinary Interstitial pneumonia (UIP): 16%; lymphocytic interstitial pneumonia (LIP): 15%; organizing pneumonia (OP): 11%
.
Most SS patients with ILD do not need a biopsy and can be monitored by PFT and blood oxygen saturation tests.
Treatment options include anti-allergic, anti-fibrosis, supportive therapy, and lung transplantation
.
The treatment process is shown in Fig.
4: Fig.
4 Treatment flow chart Note: PH=Pulmonary Hypertension; MMF=Mycophenolate Mofetil; AZA=Azathioprine; RTX=Rituximab; CYC=Cyclophosphamide; CYP=Liver Drug Enzyme Approximately 50% of patients with SS have small lung nodules, and guidelines are needed to assess the risk of lung cancer
.
Patients with SS also have a certain risk of complicated lymphoma.
Malignant mucosa-associated lymphoid tissue (MALT) lymphoma is common, which may have small nodules and consolidation
.
For the nodule diameter ≥ 8mm, PET examination has a certain prompting effect
.
When necessary, biopsy can be performed by bronchoscopy, CT-guided puncture, or surgery
.
The imaging results of common manifestations of lung diseases in SS patients are shown in Figure 5: Figure 5 Common imaging results of cystic lung disease of Sjogren’s syndrome Professor Carteron focused on cystic lung disease related content in the lecture
.
She first reviewed the SICCA scoring criteria: 4 or more items meet the SS classification criteria: SSA, SSB, RF, ANA-IFA (3 points); corneal fluorescence staining (OSS) ≥ 5 (1 point); tear secretion ≤ 5mm (1 point); the overall saliva flow rate (UWSF) ≤0.
1ml/min (1 point) in the non-stimulated state; the lip salivary gland biopsy (LSGB) score ≥1 (3 points)
.
An example of the imaging examination results of SS patients with cystic lung disease is shown in Figure 6.
It can be seen that the lesion volume is usually larger
.
Figure 6 Typical imaging results of SS-cystic lung disease Cystic lung disease is more common in SS than in other connective tissue diseases.
It is generally believed to be related to LIP and lymphfollicular bronchiolitis, and may indicate amyloid or MALT lymphoma
.
The cyst may be infected or it may rupture and cause a pneumothorax
.
The occurrence of cystic lung disease may be related to aging, secondary SS, and SSA+ or SSB+.
This direction still needs more research to understand
.
Expert profile Gao Jie, deputy chief physician, associate professor, and doctor of medicine
.
Director of Department of Rheumatology and Immunology of Shanghai Changhai Hospital, Youth Committee of Rheumatology Branch of Chinese Medical Association, Youth Committee of Osteoporosis and Bone Mineral Diseases Branch of Chinese Medical Association, Member of Rheumatology Branch of Shanghai Medical Association, Bone of Shanghai Medical Association Member of the Porosity Specialty Branch, has long been engaged in clinical scientific research on rheumatic osteoporosis
.
How to manage lung disease in SS patients? Experts interpret the latest consensus.
This issue of "The Youth Committee of the Society of Rheumatology Takes You to ACR 2021" will be lectured by Dr.
Augustine Lee and Professor Nancy Carteron at the 2021 American Society of Rheumatology (ACR) Annual Conference, and will be interpreted by Professor Gao Jie from Shanghai Changhai Hospital.
"Guideline Interpretation: Consensus on Evaluation and Management of Sjögren’s Syndrome Pulmonary Disease
.
"
Dr.
Lee first introduced the guide
.
About one-sixth of patients with Sjogren’s syndrome (SS) have lung damage.
A consensus guideline on the assessment and management of SS lung disease was recently published (Figure 1), containing 52 practical recommendations
.
Figure 1 The pulmonary manifestations, diagnostic methods and management points of SS on the cover of the guide.
Common manifestations of lung disease in SS patients include: SS patients without respiratory symptoms; cough; interstitial lung disease (ILD); small nodules; consolidation; Cystic lung disease in SS patients
.
Let's first look at patients with SS who have no respiratory symptoms
.
Do such patients need to undergo imaging tests? The answer is yes.
It can be checked by rechecking symptoms (such as coughing and sputum, chest tightness, shortness of breath, etc.
), X-rays, and a full set of pulmonary function tests (PFT)
.
An average of 10% to 20%, and up to 65% of SS patients will have pulmonary complications, so screening is necessary
.
The full set of PFT refers to: spirometry: Is it obstructive? (FEV1, FVC); lung volume measurement: is it restricted? (TLC, TV); Diffusion capacity (DLCO): To assess the presence of lung parenchyma & pulmonary vascular abnormalities; Oxygen saturation: at rest & exercise
.
Evaluation of patients without respiratory symptoms SS shown in Figure 2: a flowchart of FIG.
2 Evaluation Note: CXR = chest X-ray; HRCT = thin CT As cough SS patients, including assessment of the PFT manner, chest CT and the like
.
Cough symptoms are also common in SS patients, and may reflect some serious abnormalities, such as ILD, tumors, etc.
, while CXR may have a missed diagnosis rate of 10% to 15%
.
The most likely cause of cough is dryness of the tracheal/bronchial mucosa.
Consider common causes including gastroesophageal reflux disease (GERD), rhinitis, and asthma
.
SS respiratory tract involvement includes three conditions, namely upper respiratory tract involvement, middle respiratory tract involvement, and lower respiratory tract involvement
.
Upper respiratory tract involvement, such as Sicca syndrome (salivary gland and lacrimal gland dysfunction), may have mouth, nose, and throat symptoms; middle respiratory tract involvement, such as tracheal/bronchial mucosa dryness, can easily cause coughing, with an incidence of 41%~61%; lower respiratory tract involvement It can be manifested as bronchiectasis, bronchiolitis, bronchial hyperresponsiveness/asthma, and the incidence of the three is 7%~54%, 12%~24% and 42%~60%, respectively
.
For SS patients with respiratory symptoms, the treatment process is shown in Figure 3: Figure 3 The treatment flow chart of SS patients with ILD accounted for about 25%, which are divided into 4 types: non-specific interstitial pneumonia (NSIP): 45%; ordinary Interstitial pneumonia (UIP): 16%; lymphocytic interstitial pneumonia (LIP): 15%; organizing pneumonia (OP): 11%
.
Most SS patients with ILD do not need a biopsy and can be monitored by PFT and blood oxygen saturation tests.
Treatment options include anti-allergic, anti-fibrosis, supportive therapy, and lung transplantation
.
The treatment process is shown in Fig.
4: Fig.
4 Treatment flow chart Note: PH=Pulmonary Hypertension; MMF=Mycophenolate Mofetil; AZA=Azathioprine; RTX=Rituximab; CYC=Cyclophosphamide; CYP=Liver Drug Enzyme Approximately 50% of patients with SS have small lung nodules, and guidelines are needed to assess the risk of lung cancer
.
Patients with SS also have a certain risk of complicated lymphoma.
Malignant mucosa-associated lymphoid tissue (MALT) lymphoma is common, which may have small nodules and consolidation
.
For the nodule diameter ≥ 8mm, PET examination has a certain prompting effect
.
When necessary, biopsy can be performed by bronchoscopy, CT-guided puncture, or surgery
.
The imaging results of common manifestations of lung diseases in SS patients are shown in Figure 5: Figure 5 Common imaging results of cystic lung disease of Sjogren’s syndrome Professor Carteron focused on cystic lung disease related content in the lecture
.
She first reviewed the SICCA scoring criteria: 4 or more items meet the SS classification criteria: SSA, SSB, RF, ANA-IFA (3 points); corneal fluorescence staining (OSS) ≥ 5 (1 point); tear secretion ≤ 5mm (1 point); the overall saliva flow rate (UWSF) ≤0.
1ml/min (1 point) in the non-stimulated state; the lip salivary gland biopsy (LSGB) score ≥1 (3 points)
.
An example of the imaging examination results of SS patients with cystic lung disease is shown in Figure 6.
It can be seen that the lesion volume is usually larger
.
Figure 6 Typical imaging results of SS-cystic lung disease Cystic lung disease is more common in SS than in other connective tissue diseases.
It is generally believed to be related to LIP and lymphfollicular bronchiolitis, and may indicate amyloid or MALT lymphoma
.
The cyst may be infected or it may rupture and cause a pneumothorax
.
The occurrence of cystic lung disease may be related to aging, secondary SS, and SSA+ or SSB+.
This direction still needs more research to understand
.
Expert profile Gao Jie, deputy chief physician, associate professor, and doctor of medicine
.
Director of Department of Rheumatology and Immunology of Shanghai Changhai Hospital, Youth Committee of Rheumatology Branch of Chinese Medical Association, Youth Committee of Osteoporosis and Bone Mineral Diseases Branch of Chinese Medical Association, Member of Rheumatology Branch of Shanghai Medical Association, Bone of Shanghai Medical Association Member of the Porosity Specialty Branch, has long been engaged in clinical scientific research on rheumatic osteoporosis
.
