Pulmonology

It is common practice to evaluate for an underlying connective tissue disease (CTD) when confronted with a patient with an "idiopathic" interstitial lung disease (ILD). There are numerous implications for identifying an underlying CTD; most significantly, CTD-ILD may be associated with a more favorable prognosis than idiopathic ILD. That being said, it is not known whether the identification of more subtle – or occult – forms of CTD carries a similarly more-favorable prognosis. It is not known whether confirming primary Sjogren's syndrome (pSS) with minor salivary gland biopsy (MSGB) impacts on either the management or prognosis of ILD patients although in general the association of diffuse lung disease with CTD is more favorable. It can be argued that future decisions that incorporate the knowledge of likely CTD might well impact on treatment choices given the better prognosis in CTD.  Clearly, more studies are needed to better determine whether diagnosing occult CTD – such as pSS - among patients with ILD impacts on therapy or prognosis.