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A radiological pattern of usual interstitial pneumonia (UIP) has long been recognised as a marker of poor prognosis in interstitial lung disease (ILD).1 While UIP is the defining pattern in idiopathic pulmonary fibrosis (IPF), it can also be seen in other ILDs, including connective tissue disease ILD (CTD-ILD) and fibrotic hypersensitivity pneumonitis (fHP).2–4 It is well understood that CTD-ILD typically follows a more indolent course than IPF, but the prognostic implications of a UIP pattern within these non-IPF diagnoses remain incompletely understood.5 6 Does the presence of UIP override disease-specific biology, or does diagnostic context remain paramount?