How do you approach screening for ILD in patients with a diagnosis of MCTD given the recommendation discrepancies between the most recent EULAR and ACR/CHEST guidelines?

Another excellent question! While the EULAR guidelines treat MCTD as SSc-equivalent and suggest universal screening, ACR/CHEST guidelines suggest risk-stratified screening with emphasis on symptoms, PFT abnormalities, and high-risk phenotypes.

Prevalence of ILD in MCTD can be high, in the range of 30...

As I go through the ACR/Chest and EULAR ILD guidelines, I do not see a significant discrepancy IF we consider MCTD in general a high-risk disease for ILD. Patients with MCTD are considered high-risk for ILD if they have scleroderma features, which are defined as Raynaud’s phenomenon, puffy fingers, ...

I do CT at baseline in all high-risk patients - MCTD is high risk for ILD. If abnormal CT, then do PFT.