Elizabeth Volkmann, MD, MS: Identifying Subclinical, Clinical Systemic Sclerosis Associated Interstitial Lung Disease

In an interview with HCPLive Rheumatology, Elizabeth Volkmann, MD, MS, discusses her Congress of Clinical Rheumatology West presentation, “Systemic Sclerosis Associated Interstitial Lung Disease (SSc-ILD): How to Evaluate Subclinical, Clinical, & Progressive Disease for Best Outcome.” Volkmann is the director of the UCLA Scleroderma Program and the founder and co-director of the UCLA Connective Tissue Disease-Related Interstitial Lung Disease (CTD-ILD) Program.

ILD affects anywhere from 65% to 88% of individuals with systemic sclerosis. Traditionally, clinicians categorized patients as either "subclinical," meaning they have evidence of interstitial lung disease on a computerized tomography (CT) scan but no noticeable symptoms like shortness of breath, cough, or exercise intolerance, or "clinical," referring to those with clear symptoms of interstitial lung disease.

“However, it's important to note these labels can be somewhat limited in capturing the full spectrum of patient experiences,” Volkmann explained. “Even those labeled as having ‘subclinical’ disease may exhibit subtle symptoms. Therefore, I prefer not to rely heavily on these terms in my practice, as patients without obvious symptoms can still have underlying, albeit subtle, signs of interstitial lung disease.”

Certain risk factors are associated with the development of progressive pulmonary fibrosis in patients with SSc-ILD, including male gender, Black patients, early disease onset, and a greater extent of skin involvement, indicating more significant skin fibrosis.

Patient education plays a pivotal role in managing SSc-ILD. Volkmann emphasized the importance of involving patients in their treatment decisions and ensuring they are well-informed.

“In addition to discussing treatment options, I stress the importance of patients being attuned to their own health,” Volkmann stated. “While I may see patients every 3 to 6 months in clinical practice, their ability to recognize changes in their condition and communicate these changes to me is invaluable. By educating patients about what to watch for in terms of disease progression and the significance of reporting any concerning symptoms promptly, we can work together as a team to achieve better outcomes.”

This transcript was edited for clarity.

Dr. Volkmann is a consultant to Boehringer Ingelheim and Forbius.