Treatment after progression on a first therapy may involve adding or switching treatments. The guideline provides a list of preferred therapies, but decisions will vary based on the clinical situation, extra-pulmonary manifestations and patient preference.
In this case, Dr. Khanna and the patient chose to add rituximab, the treatment listed right after mycophenolate (if it has not already been employed) for all five subtypes.
The guideline also contains recommendations for management of rapidly progressive ILD, although this was not relevant in the clinical case study because rapidly progressive disease is rare in systemic sclerosis.
A guideline summary with additional details on screening and monitoring is currently available online, as well as a summary on treatment. The full guideline manuscripts are under peer review, with publication anticipated in the spring of 2024.
Ruth Jessen Hickman, MD, is a graduate of the Indiana University School of Medicine. She is a freelance medical and science writer living in Bloomington, Ind.
References
- Johnson SR, Bernstein EJ, Bolster MB, et al. 2023 American College of Rheumatology (ACR) Guideline for the screening and monitoring of interstitial lung disease in people with systemic autoimmune rheumatic diseases. Arthritis & Rheumatology. 2023; In preparation 2023.
- Johnson SR, Bernstein EJ, Bolster MB, et al. 2023 American College of Rheumatology (ACR) Guideline for the treatment of interstitial lung disease in people with systemic autoimmune rheumatic diseases. Arthritis & Rheumatology. 2023; In preparation 2023.
- 2023 American College of Rheumatology (ACR) guideline for the screening and monitoring of interstitial lung disease in people with systemic autoimmune rheumatic disease: Guideline summary.
- 2023 American College of Rheumatology (ACR) guideline for the treatment of interstitial lung disease in people with systemic autoimmune rheumatic disease: Guideline summary.
