A Combined Rheumatology/ILD Service. The Wolverhampton Experience

Introduction: Interstitial lung diseases (ILD), in the context of rheumatological disorders, present difficult diagnostic and management challenges.A combined rheumatology-ILD service has a potential to improve clinical outcomes in CTD-ILD. New Cross Hospital, a large district general hospital commenced providing this service in 2014 and we present an audit data over a 2 year period. Aims: To assess the effectiveness of combine rheumatology/ILD service at New Cross Hospital. Methods: A retrospective analysis of CTD-ILD clinic data over 2 years (January 2014- December 2015) was carried out. 78 patients, with known CTD, seen by both rheumatology and respiratory consultants in a combined clinical setting. All patients had proven pulmonary fibrosis on HRCT Chest. Results: Of the 78 patients, 10 patients (12%) had change in the diagnosis after clinic review. All patients (100%) had full lung functions after their first combined clinic review. Twenty five patients (32%) had a change in their management, (5 were treated with IV cyclophosphamide, 19 had an increase in prednisolone dosage while one patient received rituximab). No patient was felt to be a suitable candidate for lung transplantation. All patients had a transthoracic echocardiogram requested at their first clinic appointment to screen for pulmonary hypertension. Conclusions: Combined Rheumatology/ILD service reduces number of outpatient clinic appointments for patients with CTD-ILD. Moreover, it alters clinical management in a significant proportion of patients, improving diagnostic accuracy and clinical therapeutics.