Proposal of a radiation-free screening protocol for early detection of interstitial lung involvement in seropositive and ACPA-positive rheumatoid arthritis
Abstract Background Seropositive rheumatoid arthritis (RA) is associated with significant cardiovascular and pulmonary morbidity. However, screening for early detection of pulmonary involvement especially interstitial lung disease (ILD) is not established in RA. Methods We propose a non-invasive rad...
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BMC
2024-11-01
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| Online Access: | https://doi.org/10.1186/s12890-024-03405-y |
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| author | Frank Reichenberger Florian Popp Martin Hoffmann Carina Fischinger Werner von Wulffen Nikolaus Kneidinger Martin Welcker |
| author_facet | Frank Reichenberger Florian Popp Martin Hoffmann Carina Fischinger Werner von Wulffen Nikolaus Kneidinger Martin Welcker |
| author_sort | Frank Reichenberger |
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| description | Abstract Background Seropositive rheumatoid arthritis (RA) is associated with significant cardiovascular and pulmonary morbidity. However, screening for early detection of pulmonary involvement especially interstitial lung disease (ILD) is not established in RA. Methods We propose a non-invasive radiation-free approach to screen for interstitial lung involvement (ILI) by means of pulmonary function tests (PFT) and pleuro-pulmonary transthoracic ultrasound (LUS) with additional cardiopulmonary exercise tests (CPET) with ECG, and echocardiography. We included patients with confirmed diagnosis of seropositive RA according to ACR criteria, but without symptoms for or known cardiopulmonary disease. ILD was suspected when significant LUS abnormalities and additional PFT changes were present. Results We included 67 consecutive patients (78% female, mean age 61 ± 12 years, 48% active or previous smokers), who fulfilled the inclusion criteria and gave written informed consent. We found 48% of patients with suspected changes in PFT with a diffusion capacity (DLCOc-SB) ≤ 80%, among them 7% with forced vital capacity (FVC) ≤ 80%. In 40% of patients, we found noticeable changes in LUS, 24% with an ILD compatible pattern. In 16% of cases, LUS abnormalities and additional PFT changes were present, and ILI was suspected. Additional findings included obstructive lung disease (n = 11), subpleural consolidation (n = 6) including one confirmed lung cancer, minimal pleural effusion (n = 6), and ischemic cardiac disease (n = 2). None of the patients showed signs of pulmonary vascular involvement. Conclusions ILI was suspected in 16% of cases using a new radiation-free screening protocol in asymptomatic RA patients. Trial registration German Register of Clinical Studies (DRKS00028871). |
| format | Article |
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| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
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| series | BMC Pulmonary Medicine |
| spelling | doaj-art-7bcba1f6bd5348c99b59b7134bb5a3822025-08-20T02:22:32ZengBMCBMC Pulmonary Medicine1471-24662024-11-012411810.1186/s12890-024-03405-yProposal of a radiation-free screening protocol for early detection of interstitial lung involvement in seropositive and ACPA-positive rheumatoid arthritisFrank Reichenberger0Florian Popp1Martin Hoffmann2Carina Fischinger3Werner von Wulffen4Nikolaus Kneidinger5Martin Welcker6Department of Pneumology, Augustinum Hospital MunichMVZ for Rheumatology Dr. M. WelckerDepartment of Pneumology, Augustinum Hospital MunichDepartment of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), LMU University Hospital, LMU MunichDepartment of Pneumology, Augustinum Hospital MunichDepartment of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), LMU University Hospital, LMU MunichMVZ for Rheumatology Dr. M. WelckerAbstract Background Seropositive rheumatoid arthritis (RA) is associated with significant cardiovascular and pulmonary morbidity. However, screening for early detection of pulmonary involvement especially interstitial lung disease (ILD) is not established in RA. Methods We propose a non-invasive radiation-free approach to screen for interstitial lung involvement (ILI) by means of pulmonary function tests (PFT) and pleuro-pulmonary transthoracic ultrasound (LUS) with additional cardiopulmonary exercise tests (CPET) with ECG, and echocardiography. We included patients with confirmed diagnosis of seropositive RA according to ACR criteria, but without symptoms for or known cardiopulmonary disease. ILD was suspected when significant LUS abnormalities and additional PFT changes were present. Results We included 67 consecutive patients (78% female, mean age 61 ± 12 years, 48% active or previous smokers), who fulfilled the inclusion criteria and gave written informed consent. We found 48% of patients with suspected changes in PFT with a diffusion capacity (DLCOc-SB) ≤ 80%, among them 7% with forced vital capacity (FVC) ≤ 80%. In 40% of patients, we found noticeable changes in LUS, 24% with an ILD compatible pattern. In 16% of cases, LUS abnormalities and additional PFT changes were present, and ILI was suspected. Additional findings included obstructive lung disease (n = 11), subpleural consolidation (n = 6) including one confirmed lung cancer, minimal pleural effusion (n = 6), and ischemic cardiac disease (n = 2). None of the patients showed signs of pulmonary vascular involvement. Conclusions ILI was suspected in 16% of cases using a new radiation-free screening protocol in asymptomatic RA patients. Trial registration German Register of Clinical Studies (DRKS00028871).https://doi.org/10.1186/s12890-024-03405-yInterstitial lung diseaseSeropositive rheumatoid arthritisNon-invasivePulmonary function testLung ultrasoundPFT |
| spellingShingle | Frank Reichenberger Florian Popp Martin Hoffmann Carina Fischinger Werner von Wulffen Nikolaus Kneidinger Martin Welcker Proposal of a radiation-free screening protocol for early detection of interstitial lung involvement in seropositive and ACPA-positive rheumatoid arthritis BMC Pulmonary Medicine Interstitial lung disease Seropositive rheumatoid arthritis Non-invasive Pulmonary function test Lung ultrasound PFT |
| title | Proposal of a radiation-free screening protocol for early detection of interstitial lung involvement in seropositive and ACPA-positive rheumatoid arthritis |
| title_full | Proposal of a radiation-free screening protocol for early detection of interstitial lung involvement in seropositive and ACPA-positive rheumatoid arthritis |
| title_fullStr | Proposal of a radiation-free screening protocol for early detection of interstitial lung involvement in seropositive and ACPA-positive rheumatoid arthritis |
| title_full_unstemmed | Proposal of a radiation-free screening protocol for early detection of interstitial lung involvement in seropositive and ACPA-positive rheumatoid arthritis |
| title_short | Proposal of a radiation-free screening protocol for early detection of interstitial lung involvement in seropositive and ACPA-positive rheumatoid arthritis |
| title_sort | proposal of a radiation free screening protocol for early detection of interstitial lung involvement in seropositive and acpa positive rheumatoid arthritis |
| topic | Interstitial lung disease Seropositive rheumatoid arthritis Non-invasive Pulmonary function test Lung ultrasound PFT |
| url | https://doi.org/10.1186/s12890-024-03405-y |
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