Lung ultrasound outperforms symptom-based screening to detect interstitial lung disease associated with rheumatoid arthritis
Marie Vermant, Alexandros Kalkanis, Joseph Jacob, Tinne Goos, Emanuela Elsa Cortesi, Heleen Cypers, Nico De Crem, Tine Follet, Stefan Gogaert, Barbara Neerinckx, V. Taelman, Nathalie Veyt, Laurens De Sadeleer, Patrick Verschueren, Wim Wuyts
Abstract
OBJECTIVES: Interstitial lung disease associated with rheumatoid arthritis (RA-ILD) is linked to high mortality. Currently, effective screening tools are lacking. We assessed the role of symptoms and lung ultrasound (LUS) as potential screening tools. METHODS: 116 adult patients with RA presenting to the rheumatology outpatient clinic underwent high-resolution CT (HRCT) scans, pulmonary function tests, LUS (72 zones) and completed a Visual Analogue Scale (VAS) for cough and modified Medical Research Council dyspnoea scale (mMRC). Kruskal-Wallis (KW) tests evaluated the correlation between clinical-radiological HRCT score (no ILD, non-specific abnormalities, subclinical ILD or ILD) and the B-lines on LUS, diffusion capacity (DLCO%pred), forced vital capacity (FVC%pred), VAS Cough and mMRC. Sensitivity and specificity analyses were performed to assess symptom-based questionnaires and the number of B-lines to detect RA-ILD. Area under the receiver operating characteristics (AUROC) for detecting clinical ILD and subclinical ILD were calculated. RESULTS: In 11.8% of patients, an ILD was detected on HRCT. Additionally, in 5%, a diagnosis of subclinical interstitial lung changes was made. The number of B-lines was most strongly associated with the clinical-radiological score (KW χ²=41.2, p=<0.001). DLCO%pred was also significantly correlated with the clinical-radiological score (KW χ²=27.4, p=<0.001), but FVC%pred, mMRC and VAS cough were not. Cough and dyspnoea only weakly predicted the ILD score in the sensitivity-specificity analyses, while B-lines showed AUROCs>0.9 for predicting subclinical and clinical ILD. CONCLUSION: LUS is a promising tool for early detection of RA-ILD, outperforming symptom-based questionnaires or the presence of dyspnoea or cough.