FRI0107 Lung ultrasound for the diagnosis of interstitial disease in rheumatoid arthritis

Background:Objectives:To analyze the diagnostic utility of lung ultrasound (US) to detect interstitial lung disease (ILD) in Rheumatoid arthritis (RA) patients comparing with high-resolution computed tomography (HRCT).Methods:Study design: We performed a cross-sectional, observational study in patients with RA-ILD (cases) controlled with a gruop of RA patients without ILD (controls) paired by sex, age and time of disease evolution.Protocol: Patients were selected between May and September 2019. Patients were interwied by two rheumathologist for the protocolized collection of clinical data. The patients were assessed using HRCT, Pulmonary Function Test (PFT) and lung US.. The rheumatology who performed the lung US were blinded to patients clinical data. Variables: (1) B-lines number; (2) evaluation of the lung- ultrasound score already described: L. Gargani, Gutiérrez comprehensivo, Gutiérrez reducido and Mohhammadi;(3)pleural irregularities; (4) A pattern US lost;(5). Other variables included demographic, clinical-analytical, therapeutic and ILD-type description. Statistical analysis: descriptive, bivariant analysis. We applied Pearson’s correlation coefficient between B-lines, PFT and clinical variable.Furthermore, to establish the cut-off point of the US B-lines number for detecting the presence of significant AR-ILD in relation to HRCT, we used the receiver operating characteristic (ROC) curve analysis. A logistic regression analysis was performed to identify the intercostal spaces (IV: B-lines number in each space) wich wereindependently associated with ILD (DV: ILD in HRCT).Results:71 patients were included, 37 (52,1%) with ILD-RA and 34 (47,95) RA controls. The main characteristics are shown in Table 1. RA-ILD presented more B-lines number than control without ILD (median ICR] 91.0 [31.0-149.0] vs 6.5 [1.5-30.5]; p=<0.001) and more pleural irregularities (PI) [PI-median(ICR) 41.0 (5.0-57.5) vs 2.5 (0.0-7.2); p<0,001]. Furthermore, RA-ILD showed a negative correlation between B-lines and DLCO(r =-0.337, p=0.048)and positive with DAS28 (r =0.347, p=0.035). Regarding US score, we found that the detection of 32.5 B-lines in 72 intercostal spaces, had aSensitivity of 75.7%, Specifity=79.4%, PPV= 80% and NPV=75%,whilst in reduced score of 10 intercostal spaces, the detection of 5.5 B-lines had a sensivity= 62.2%,Specifity= 91.3%, PPV=88.4%, NPV=69.5%. In multivariate analysis, the intercostal spaces which showed independent association with ILD were 3rdright anterior axillary space(OR [IC 95%] 19.0 [1.3-27.5]), 8thright posterior axillary space (OR [IC 95%] 0.04 [0.0-0.6]), 8thright subescapular space (OR [IC 95%] 16.5 [1.8-45.5]),9thright paravertebral space (OR [IC 95%] 7.11 [1.0-37.1]) and 2ndleft clavicular middle space(OR [IC 95%] 21.9 [1,26-37.8]).Conclusion:Lung Ultrasoud could be a useful tool for interstitial lung disease diagnosis associated with Rheumatoid Artrithis. A 10 space reduced score showed a similar total predictive capacity than 72-space scoreReferences:Disclosure of Interests:None declared

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Lung ultrasound in patients with rheumatoid arthritis and the definition of significant interstitial lung disease

10.21203/rs.3.rs-18869/v2 ◽

2020 ◽

Author(s):

Marco Di Carlo ◽

Marika Tardella ◽

Emilio Filippucci ◽

Marina Carotti ◽

Fausto Salaffi

Keyword(s):

Rheumatoid Arthritis ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Roc Curve ◽

Lung Ultrasound ◽

Smoking Habit ◽

Curve Analysis ◽

Roc Curve Analysis ◽

The Mean ◽

B Lines

Abstract Background. In recent years, a growing interest has grown around interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA). While high resolution computed tomography (HRCT) of the chest remains the diagnostic method of choice, increasing attention has been directed towards lung ultrasound (LUS) in the diagnosis of ILD in connective tissue diseases. However, in patients with RA it is not yet clear how to interpret, in quantitative terms, the presence of B-lines, the LUS artifact indicative of ILD. The aim of this study was to determine the cut-off number of LUS B-lines that identifies a significant RA-ILD.Methods. A cross sectional study was conducted on consecutive RA patients with suspected RA-ILD. The inclusion criteria were clinical (dyspnea, velcro sounds), instrumental (suggestive anomalies on conventional radiography, DLco reduction), or in presence of at least two of the following risk factors for RA-ILD: smoking habit, male sex, advanced age, and ACPA presence.Patients underwent LUS (carried out in 14 defined intercostal spaces), chest HRCT, pulmonary function tests, and clinical evaluation. The diagnosis of RA-ILD was based on a semi-quantitative evaluation of chest HRCT using a computer-aided method (CaM). The discriminative validity of the LUS versus HRCT has been studied by using the receiver operating characteristic (ROC) curve analysis.Results. 72 consecutive RA patients (21 male, 51 female) were evaluated, with a mean age of 63.0 (SD 11.5 years). The mean estimate of pulmonary fibrosis using the CaM was 11.20% (SD 7.48) at chest HRCT, while at LUS the mean number of B-lines was 10.65 (SD 15.11). A significant RA-ILD, as measured by the CaM at HRCT, was detected in 25 patients (34.7%). The presence of 9 B-lines was found to be the optimal cut-off at ROC curve analysis. This LUS cut-off defines the presence of significant RA-ILD with a sensitivity of 70.0%, a specificity of 97.62%, and a positive likelihood ratio of 29.4.Conclusion. The present study provided data to determine the number of B-lines to identify a significant RA-ILD. LUS may represent a useful technique to select RA patients to be assessed by chest HRCT.

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Lung interstitial disease secondary to SARS-CoV-2 infection in a patient with rheumatoid arthritis

Revista Virtual de la Sociedad Paraguaya de Medicina Interna ◽

10.18004/rvspmi/2312-3893/2021.08.02.120 ◽

2021 ◽

Vol 8 (2) ◽

pp. 120-128

Author(s):

Stefany Thalia Carrión Merino ◽

Ariana Priscila Jumbo Jiménez ◽

Leonel Alberto Dajaro Castro ◽

Enrique Feliciano Jaramillo Loaiza ◽

Jefferson Alexander Quelal Fernández ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Interstitial Disease

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Lung ultrasound in patients with rheumatoid arthritis and the definition of significant interstitial lung disease

10.21203/rs.3.rs-18869/v1 ◽

2020 ◽

Author(s):

Marco Di Carlo ◽

Marika Tardella ◽

Emilio Filippucci ◽

Marina Carotti ◽

Fausto Salaffi

Keyword(s):

Rheumatoid Arthritis ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Roc Curve ◽

Lung Ultrasound ◽

Smoking Habit ◽

Curve Analysis ◽

Roc Curve Analysis ◽

The Mean ◽

B Lines

Abstract Background In recent years, a growing interest has grown around interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA). While high resolution computed tomography (HRCT) of the chest remains the diagnostic method of choice, increasing attention has been directed towards lung ultrasound (LUS) in the diagnosis of ILD in connective tissue diseases. However, it is not yet well defined how to interpret the LUS findings under suspicion of RA-ILD. The aim of this study was to determine the cut-off number of LUS B-lines that identifies a significant RA-ILD. Methods A cross sectional study was conducted on consecutive RA patients with suspected RA-ILD. The inclusion criteria were clinical (dyspnea, velcro sounds), instrumental (suggestive anomalies on conventional radiography, DLco reduction), or in presence of at least two of the following risk factors for RA-ILD: smoking habit, male sex, advanced age, and ACPA presence. Patients underwent LUS (carried out in 14 defined intercostal spaces), chest HRCT, pulmonary function tests, and clinical evaluation. The diagnosis of RA-ILD was based on a semi-quantitative evaluation of chest HRCT using a computer-aided method (CaM). The discriminative validity of the LUS versus HRCT has been studied by using the receiver operating characteristic (ROC) curve analysis. Results 72 consecutive RA patients (21 male, 51 female) were evaluated, with a mean age of 63.0 (SD 11.5 years). The mean estimate of pulmonary fibrosis using the CaM was 11.20% (SD 7.48) at chest HRCT, while at LUS the mean number of B-lines was 10.65 (SD 15.11). A significant RA-ILD, as measured by the CaM at HRCT, was detected in 25 patients (34.7%). The presence of 9 B-lines was found to be the optimal cut-off at ROC curve analysis. This LUS cut-off defines the presence of significant RA-ILD with a sensitivity of 70.0%, a specificity of 97.62%, and a positive likelihood ratio of 29.4. Conclusion The present study provided data to determine the number of B-lines to identify a significant RA-ILD. LUS may represent a useful technique to select RA patients to be assessed by chest HRCT.

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Imaging Features of the Pleuropulmonary Manifestations of Rheumatoid Arthritis: Pearls and Pitfalls

Journal of Clinical Imaging Science ◽

10.4103/2156-7514.82244 ◽

2011 ◽

Vol 1 ◽

pp. 32 ◽

Cited By ~ 7

Author(s):

Harbir S Sidhu ◽

Gauraang Bhatnagar ◽

Pervinder Bhogal ◽

Richard Riordan

Keyword(s):

Rheumatoid Arthritis ◽

Lung Disease ◽

Current Knowledge ◽

Systemic Disease ◽

Pulmonary Nodules ◽

Imaging Features ◽

Interstitial Disease ◽

The Common ◽

Prognostic Implications

Rheumatoid arthritis (RA) is a common disorder that affects the joints. RA is a systemic disease associated with relatively frequent and variable pleuropulmonary manifestations. This article reviews the common and potentially serious thoracic sequelae in terms of pleural disease, pulmonary nodules, airways disorders, and interstitial disease, as well as pulmonary side effects of antirheumatic medication. An imaging-guided approach to classification of RA-associated lung disease is outlined and the comparative values of different imaging modalities are discussed. An appreciation of current knowledge of epidemiology, pathological correlation, and prognostic implications of different RA-associated lung disease is provided. We highlight importance of considering pertinent differential diagnoses to avoid misdiagnosis, and outline common pitfalls in dealing with pleuropulmonary rheumatoid disease.

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Short follow-up of multisystem inflammatory syndrome after covid19 infection in children: case report

10.21203/rs.3.rs-379656/v1 ◽

2021 ◽

Author(s):

Angelo M. Acquafredda ◽

Chiara Lorusso ◽

Anna L. S. Di Giovinazzo ◽

Anna Maria Pastoressa ◽

Maria Simone ◽

...

Keyword(s):

Total Cholesterol ◽

Inflammatory Markers ◽

Lung Ultrasound ◽

Gastrointestinal Symptoms ◽

Recovery Phase ◽

Kawasaki Syndrome ◽

Clinical Recovery ◽

Interstitial Disease ◽

Inflammatory Syndrome

Abstract Background: covid19 infection, in children compared to adults, often occurs in a pauci and/or asymptomatic manner, but in some cases, a multisystem inflammatory syndrome (MIS) may occur in the 4-6 weeks following the infection. There are few data on the features of MIS after the clinical recovery phase, therefore we have described three cases of children with post-covid19 infection syndrome. Case presentation: out of the three cases described, in two children the onset clinical symptoms were similar to Kawasaki syndrome, while in the other neurological impairment was prevalent. In none of the three there were gastrointestinal symptoms, while the signs of interstitial disease were constant on lung ultrasound. In all of them, there was an increase in the inflammatory markers, high levels of ferritin, lymphocytopenia and thrombocytopenia only in one case. The lipid profile at onset was characterized by an increase in triglyceride levels. In all cases the course was benign with resolution of the symptoms upon admission within 4-5 days. After 1 month from the clinical recovery phase, the patients showed normalization of cytokines, inflammatory markers and triglyceride levels, while the total cholesterol value increased. Covid19 infection leads to an acute phase response with increase of the triglyceride in addition to inflammatory markers and the signs of interstitial disease on lung ultrasound. Conclusions: the inflammatory markers and lung involvement normalize over 30 days, while an initial increase of the triglyceride - and later in total cholesterol - suggest a direct relationship between triglyceride and inflammatory markers at the beginning, and between total cholesterol and host immune response during the follow-up.

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The role of lung ultrasound B-lines and serum KL-6 in the screening and follow-up of rheumatoid arthritis patients for an identification of interstitial lung disease: review of the literature, proposal for a preliminary algorithm, and clinical application to cases

Arthritis Research & Therapy ◽

10.1186/s13075-021-02586-9 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Yukai Wang ◽

Shaoqi Chen ◽

Shaoyu Zheng ◽

Jianqun Lin ◽

Shijian Hu ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Clinical Practice ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Lung Ultrasound ◽

Pulmonary Function Tests ◽

Usual Interstitial Pneumonia ◽

Long Term Outcome ◽

B Lines

AbstractScreening and follow-up of interstitial lung disease associated with rheumatoid arthritis (RA-ILD) is a challenge in clinical practice. In fact, the majority of RA-ILD patients are asymptomatic and optimal tools for early screening and regular follow-up are lacking. Furthermore, some patients may remain oligosymptomatic despite significant radiological abnormalities. In RA-ILD, usual interstitial pneumonia (UIP) is the most frequent radiological and pathological pattern, associated with a poor prognosis and a high risk to develop acute exacerbations and infections. If RA-ILD can be identified early, there may be an opportunity for an early treatment and close follow-up that might delay ILD progression and improve the long-term outcome.In connective tissue disease–associated interstitial lung disease (CTD-ILD), lung ultrasound (LUS) with the assessment of B-lines and serum Krebs von den Lungen-6 antigen (KL-6) has been recognized as sensitive biomarkers for the early detection of ILD. B-line number and serum KL-6 level were found to correlate with high-resolution computed tomography (HRCT), pulmonary function tests (PFTs), and other clinical parameters in systemic sclerosis–associated ILD (SSc-ILD). Recently, the significant correlation between B-lines and KL-6, two non-ionizing and non-invasive biomarkers, was demonstrated. Hence, the combined use of LUS and KL-6 to screen and follow up ILD in RA patients might be useful in clinical practice in addition to existing tools. Herein, we review relevant literature to support this concept, propose a preliminary screening algorithm, and present 2 cases where the algorithm was used.

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