Figures
- FIGURE 1
“Mechanic hands” characterised by distal digital fissuring and cracking of the skin.
- FIGURE 2
Gottron's sign characterised by fixed erythematous rash over the meta-carpal phalangeal joints. Note also the presence of periungual erythema.
- FIGURE 3
Bibasilar reticulation and traction bronchiectasis with minimal ground glass opacifications consistent with fibrotic non-specific interstitial pneumonia. Note also the presence of a dilated fluid-filled oesophagus.
- FIGURE 4
High-resolution computed tomography image suggesting non-specific interstitial pneumonia with organising pneumonia.
- FIGURE 5
High-resolution computed tomography image suggesting lymphocytic interstitial pneumonia. Note the extensive peribronchovascular cysts.
- FIGURE 6
Photomicrograph of histopathology slide demonstrating fibrotic non-specific interstitial pneumonia pattern. Note the uniform thickening of all of the alveolar walls and scant chronic inflammation.
- FIGURE 7
Photomicrograph of histopathology slide demonstrating lymphocytic interstitial pneumonia pattern.
- FIGURE 8
Photomicrograph of histopathology slide demonstrating follicular bronchiolitis with background pattern of non-specific interstitial pneumonia pattern. Note the large reactive lymphoid follicles (F) surrounding a bronchiole (BR).
- FIGURE 9
Photomicrograph of histopathology slide demonstrating chronic pleuritis overlying cellular non-specific interstitial pneumonia pattern.
Tables
- TABLE 1
Classification criteria for “interstitial pneumonia with autoimmune features”
Presence of an interstitial pneumonia (by HRCT or surgical lung biopsy) and,
Exclusion of alternative aetiologies and,
Does not meet criteria of a defined connective tissue disease and,
At least one feature from at least two of these domains:
A. Clinical domain
B. Serologic domain
C. Morphologic domain
A. Clinical domain
Distal digital fissuring (i.e. “mechanic hands”)
Distal digital tip ulceration
Inflammatory arthritis or polyarticular morning joint stiffness ≥60 min
Palmar telangiectasia
Raynaud's phenomenon
Unexplained digital oedema
Unexplained fixed rash on the digital extensor surfaces (Gottron's sign)
B. Serologic domain
ANA ≥1:320 titre, diffuse, speckled, homogeneous patterns or
a. ANA nucleolar pattern (any titre) or
b. ANA centromere pattern (any titre)
Rheumatoid factor ≥2× upper limit of normal
Anti-CCP
Anti-dsDNA
Anti-Ro (SS-A)
Anti-La (SS-B)
Anti-ribonucleoprotein
Anti-Smith
Anti-topoisomerase (Scl-70)
Anti-tRNA synthetase (e.g. Jo-1, PL-7, PL-12; others are: EJ, OJ, KS, Zo, tRS)
Anti-PM-Scl
Anti-MDA-5
C. Morphologic domain
Suggestive radiology patterns by HRCT (see text for descriptions):
a. NSIP
b. OP
c. NSIP with OP overlap
d. LIP
Histopathology patterns or features by surgical lung biopsy:
a. NSIP
b. OP
c. NSIP with OP overlap
d. LIP
e. Interstitial lymphoid aggregates with germinal centres
f. Diffuse lymphoplasmacytic infiltration (with or without lymphoid follicles)
Multi-compartment involvement (in addition to interstitial pneumonia):
a. Unexplained pleural effusion or thickening
b. Unexplained pericardial effusion or thickening
c. Unexplained intrinsic airways disease# (by PFT, imaging or pathology)
d. Unexplained pulmonary vasculopathy
HRCT: high-resolution computed tomography; ANA: antinuclear antibody; NSIP: non-specific interstitial pneumonia; OP: organising pneumonia; LIP: lymphoid interstitial pneumonia; PFT: pulmonary function testing. #: includes airflow obstruction, bronchiolitis or bronchiectasis.
Disclosures
Supplementary material
Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.
