Contribution of pulmonary function tests (PFTs) to the diagnosis and follow up of connective tissue diseases

Introduction: Connective Tissue Diseases (CTDs) are systemic autoimmune conditions characterized by frequent lung involvement. This usually takes the form of Interstitial Lung Disease (ILD), but Obstructive Lung Disease (OLD) and Pulmonary Artery Hypertension (PAH) can also occur. Lung involvement is often severe, representing the first cause of death in CTD. The aim of this study is to highlight the role of Pulmonary Function Tests (PFTs) in the diagnosis and follow up of CTD patients. Main body: Rheumatoid Arthritis (RA) showed mainly an ILD with a Usual Interstitial Pneumonia (UIP) pattern in High-Resolution Chest Tomography (HRCT). PFTs are able to highlight a RA-ILD before its clinical onset and to drive follow up of patients with Forced Vital Capacity (FVC) and Carbon Monoxide Diffusing Capacity (DLCO). In the course of Scleroderma Spectrum Disorders (SSDs) and Idiopathic Inflammatory Myopathies (IIMs), DLCO appears to be more sensitive than FVC in highlighting an ILD, but it can be compromised by the presence of PAH. A restrictive respiratory pattern can be present in IIMs and Systemic Lupus Erythematosus due to the inflammatory involvement of respiratory muscles, the presence of fatigue or diaphragm distress. Conclusions: The lung should be carefully studied during CTDs. PFTs can represent an important prognostic tool for diagnosis and follow up of RA-ILD, but, on their own, lack sufficient specificity or sensitivity to describe lung involvement in SSDs and IIMs. Several composite indexes potentially able to describe the evolution of lung damage and response to treatment in SSDs are under investigation. Considering the potential severity of these conditions, an HRCT jointly with PFTs should be performed in all new diagnoses of SSDs and IIMs. Moreover, follow up PFTs should be interpreted in the light of the risk factor for respiratory disease related to each disease.

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Abnormal Nailfold Capillaroscopy Is Common in Patients with Connective Tissue Disease and Associated with Abnormal Pulmonary Function Tests

The Journal of Rheumatology ◽

10.3899/jrheum.180615 ◽

2018 ◽

Vol 46 (9) ◽

pp. 1109-1116 ◽

Cited By ~ 5

Author(s):

Anniek M. van Roon ◽

Cato C. Huisman ◽

Arie M. van Roon ◽

Dan Zhang ◽

Alja J. Stel ◽

...

Keyword(s):

Connective Tissue ◽

Pulmonary Function ◽

Connective Tissue Disease ◽

Lupus Erythematosus ◽

Pulmonary Function Tests ◽

Connective Tissue Diseases ◽

Definite Diagnosis ◽

Predictive Values ◽

Function Tests ◽

Abnormal Pulmonary Function

Objective.To assess the presence of a systemic sclerosis (SSc) pattern on nailfold capillary microscopy (NCM) in patients with Raynaud phenomenon (RP) and to explore its association with abnormal pulmonary function tests (PFT).Methods.NCM patterns were assessed in 759 consecutive patients with RP. Patterns were classified as normal (n = 354), nonspecific (n = 159), or SSc pattern (n = 246). Abnormal PFT was defined as forced vital or diffusion capacity < 70%. Patients were classified as primary RP (n = 245), or secondary: no definite diagnosis (n = 391), SSc (n = 40), primary Sjögren syndrome (pSS; n = 30), systemic lupus erythematosus (SLE; n = 30), mixed connective tissue disease (MCTD; n = 7), rheumatoid arthritis (RA; n = 15).Results.An SSc pattern on NCM was frequently observed in most patients with a definite diagnosis: SSc (88%), pSS (33%), SLE (17%), MCTD (71%), and RA (13%). In patients without definite diagnosis, 17% had a normal NCM pattern, 35% nonspecific, and 48% SSc pattern. Abnormal PFT was more frequent in patients with an SSc pattern (35.9% vs 19.5%, p = 0.002), even when corrected for SSc diagnosis (p = 0.003). Absence of an SSc pattern had high negative predictive value (88%); positive predictive values were low.Conclusion.SSc pattern on NCM is common in patients with RP, and in those with connective tissue diseases other than SSc. It is associated with a higher prevalence of abnormal PFT, independent of the presence of an SSc diagnosis. Although these data need validation in a prospective setting, they underline the importance of NCM in RP and putative value to stratify the risk of pulmonary involvement in early stages of disease.

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SAT0193 Pulmonary function tests in patients with connective tissue diseases

10.1136/annrheumdis-2001.691 ◽

2001 ◽

Author(s):

K Borysewicz

Keyword(s):

Connective Tissue ◽

Pulmonary Function ◽

Pulmonary Function Tests ◽

Connective Tissue Diseases ◽

Function Tests

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Pulmonary Function Tests in Connective Tissue Disease

Seminars in Respiratory and Critical Care Medicine ◽

10.1055/s-2007-985610 ◽

2007 ◽

Vol 28 (4) ◽

pp. 379-388 ◽

Cited By ~ 17

Author(s):

Athol Wells

Keyword(s):

Connective Tissue ◽

Pulmonary Function ◽

Connective Tissue Disease ◽

Pulmonary Function Tests ◽

Function Tests

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A study of respiratory system involvement in autoimmune connective tissue diseases: a marker of morbidity

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20202660 ◽

2020 ◽

Vol 6 (4) ◽

pp. 532

Author(s):

Neha T. Solanki ◽

Sahana P. Raju ◽

Deepmala Budhrani ◽

Bharti K. Patel

Keyword(s):

Systemic Sclerosis ◽

Interstitial Lung Disease ◽

Connective Tissue ◽

Pulmonary Function ◽

Lung Disease ◽

Pulmonary Function Tests ◽

Tertiary Care ◽

Connective Tissue Diseases ◽

Cutaneous Manifestations ◽

Respiratory Involvement

Background: The auto-immune connective tissue diseases (AICTD) are polygenic clinical disorders having heterogeneous overlapping clinical features. Certain features like autoimmunity, vascular abnormalities, arthritis/arthralgia and cutaneous manifestations are common to them. Lung involvement can present in AICTDs in form of: pleurisy, acute/ chronic pneumonitis, pulmonary artery hypertension (PAH), shrinking lung syndrome, diffuse alveolar damage, pulmonary embolism (PE), bronchiolitis obliterans organizing pneumonia, pulmonary infections, cardiogenic pulmonary edema, etc. High-resolution computed tomography (HRCT) plays an important role in identifying patients with respiratory involvement. Pulmonary function tests are a sensitive tool detecting interstitial lung disease.Methods: The present study is an observational study carried out on 170 patients of AICTD in department of Dermatology, Venereology and Leprosy at a tertiary care centre during a period of 2 years from October 2017 to August 2019. Detailed history, examination and relevant investigations like chest X-ray, pulmonary function test (PFT), HRCT thorax were done as indicated.Results: The overall incidence of respiratory involvement was 56.7% with maximum involvement in systemic sclerosis cases (82.8% of cases). 45.7% of patients of systemic lupus erythematosus had respiratory involvement, most common being pleural effusion in 11.5%. Impaired PFT’s were seen in 82.8% cases of systemic sclerosis (SSc) and all cases of UCTD. Interstitial lung disease was seen in 34.7% and 25% cases of SSc and DM respectively. PAH was found in 15.2% cases of SSc and 9.8% cases of mixed connective tissue diseases.Conclusions: AICTD are multisystem disorders in which pulmonary involvement can be an important cause of morbidity to the patient and early detection is necessary for prevention of long-term respiratory complications.

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RE: Association of Abnormal Pulmonary Vasculature on CT Scan for COVID-19 Infection with Decreased Diffusion Capacity in Follow Up: a retrospective cohort study.

10.21203/rs.3.rs-253280/v1 ◽

2021 ◽

Author(s):

Daniel Salerno ◽

Ifeoma Oriaku ◽

Melinda Darnell ◽

Maarten Lanclus ◽

Jan De Backer ◽

...

Keyword(s):

Pulmonary Function ◽

Ct Scan ◽

Pulmonary Function Tests ◽

Systemic Disease ◽

Inflammatory Biomarkers ◽

Pulmonary Vasculature ◽

Healthy Controls ◽

Tissue Segmentation ◽

Function Tests

Abstract Background: Coronavirus Disease 2019 (COVID-19) is a highly contagious respiratory viral illness causing pneumonia and systemic disease. Abnormalities in pulmonary function after COVID-19 infection have been described. The determinants of these abnormalities are unclear. We hypothesized that inflammatory biomarkers and CT scan parameters at the time of infection would be associated with abnormal gas exchange at short term follow-up.Methods: We studied subjects who were hospitalized for COVID-19 pneumonia and then discharged. Serum inflammatory biomarkers, CT scan, and clinical characteristics were assessed during the hospitalization. CT images were evaluated by Functional Respiratory Imaging with automated tissue segmentation algorithms of the lungs and pulmonary vasculature. Volumes of the pulmonary vessels that were ≤5mm (BV5), 5-10mm (BV5_10), and ≥10mm (BV10) in cross sectional area were analyzed. Additionally, the amount of opacification on CT (i.e. ground glass opacities) was quantified in each patient. Pulmonary function tests were performed 2-3 months after discharge. We divided subjects into those with a DLCO <80% predicted (Low DLCO) and those with a DLCO ≥80% predicted (Normal DLCO) based on these pulmonary function tests. Results: 38 subjects were included in our analysis. 31 out of 38 (81.6%) subjects had a DLCO<80% predicted. Hemoglobin, inflammatory biomarkers, spirometry and lung volumes were similar between groups. CT opacification and BV5 were not different between groups, but both Low and Normal DLCO groups had lower BV5 measures compared to healthy controls. BV5_10 and BV10 measures were higher in the Low DLCO group compared to the Normal DLCO group. Both BV5_10 and BV10 in the Low DLCO group were greater compared to healthy controls. BV5_10 was independently associated with DLCO<80% in multivariable logistic regression (OR 1.29, 95% CI 1.01, 1.64). BV10 negatively correlated with DLCO% predicted (r=-0.343, p=0.035). Conclusions: Low DLCO is common after COVID-19 infection, and abnormalities in pulmonary vascular volumes at the time of hospitalization are independently associated with a low DLCO. There was no relationship between inflammatory biomarkers during hospitalization and DLCO. These findings suggest that pulmonary vascular abnormalities during hospitalization with COVID-19 might have long-lasting effects on pulmonary function.

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