Clinical practice guideline for the diagnosis and treatment of interstitial lung disease associated with systemic sclerosis and rheumatoid arthritis in Colombia. Colombian Rheumatology Association (Asoreuma) and Colombian Association of Pulmonology and Thoracic Surgery (ASONEUMOCITO)

Abstract

Objective: To develop evidence-based recommendations for the screening, diagnosis, treatment, and follow-up of interstitial lung disease associated with systemic sclerosis (SSc-ILD) and rheumatoid arthritis (RA-ILD), applicable to current medical practice in Colombia. Methods: A multidisciplinary team of rheumatologists, pulmonologists, and radiologists with expertise in interstitial lung diseases was convened by ASONEUMOCITO and Asoreuma to develop national clinical practice guidelines for SSc-ILD and RA-ILD. Using standardized processes for evidence review and appraisal, and following the GRADE methodology, recommendations were formulated based on the balance of benefits and risks, patient values and preferences, equity, and resource use. Results: A total of 55 recommendations were developed for SSc-ILD and RA-ILD. These recommendations cover screening and diagnosis via clinical evaluation, pulmonary function tests, and high-resolution computed tomography (HRCT) of the chest. The first-line treatment for SSc-ILD includes immunosuppressive agents, while the first-line treatment for RA-ILD includes conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Depending on patient characteristics and prior treatment exposure, these may be followed by biological agents, JAK inhibitors, or antifibrotic therapies. Other interventions, such as lung or bone marrow transplantation, oxygen therapy, pulmonary rehabilitation, and palliative care, are considered in specific clinical scenarios. Regular follow-up is essential to detect disease progression and guide timely therapeutic decisions. Conclusions: These guidelines—Colombia's first national recommendations for the management of SSc-ILD and RA-ILD—provide evidence-based guidance tailored to the country's healthcare context and available resources, aiming to promote comprehensive and high-quality care for patients affected by these conditions.