Management of interstitial lung disease in systemic autoimmune rheumatic diseases: a survey of rheumatologists and pulmonologists

Objectives: To determine whether rheumatologists and pulmonologists have distinct disciplinary approaches to the management of systemic autoimmune rheumatic disease (SARD)-interstitial lung disease (ILD). Methods: This was a cross-sectional survey study of US rheumatologists and pulmonologists. Surveys were electronically distributed to physicians identified through professional societies and social media. Surveys contained case questions on SARD-ILD management for patients with mixed connective tissue disease, idiopathic inflammatory myopathy, rheumatoid arthritis, systemic sclerosis and Sjogren's with varying ILD severity (asymptomatic, symptomatic, progressive). Respondents also answered questions on treatment decision-making, comfort with pharmacologic modalities and opinions about interdisciplinary co-management. We analyzed responses submitted 5-9/2024. We compared specialists' responses via univariate logistic regression, Chi-squared or Fisher's exact tests; we performed multivariable logistic regression of case questions controlling for practice setting, clinical experience and geographic region. Results: Analyses included 309 participants (rheumatologists = 184, pulmonologists = 125). Compared with pulmonologists, rheumatologists were less likely to treat asymptomatic and symptomatic ILD with corticosteroids for all SARD except asymptomatic systemic sclerosis (odds ratios [OR] 0.14-0.45), and to treat progressive ILD with antifibrotics (OR 0.26-0.30). Conversely, rheumatologists were more likely than pulmonologists to either add or modify immunomodulation/immunosuppression for all symptomatic and progressive SARD-ILD (OR 1.82-5.44). There were disciplinary differences in the relative importance of clinical variables to treatment approaches. Specialists reported ownership over different domains of treatment decision-making and healthcare maintenance. Conclusion: This national study suggests distinct disciplinary approaches to management of SARD-ILD, and highlights opportunities to leverage complementary expertise through a co-management paradigm.