AB0510 LUNG ULTRASOUND OF PLEURAL IRREGULARITIES IN SUB-CLINICAL PRIMARY SJÖGREN’S SYNDROME-LUNG INVOLVEMENT: A SINGLE CENTRE EXPERIENCE
Authors: Francesco Ferro, Alessandra Bulleri, Elena Elefante, Alessandra Tripoli, Marta Mosca, Chiara Baldini
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Ultrasound of Pleural Irregularities (PI-US) has recently been suggested as a useful tool for the diagnosis and quantification of severity in connective tissue diseases (CTD)-related lung involvement. However, no data are available regarding its role in the sub-clinical phase of primary Sjögren's syndrome (pSS)-related lung involvement. <h3>Objectives:</h3> Aim of this study was to describe the role of lung ultrasound analyzing pleural irregularities in asymptomatic pSS-patients in order to early detect lung abnormalities/alterations. Methods: pSS patients regularly followed-up at our Sjögren's Clinic and asymptomatic for dyspnea and cough, undergoing to CT or HRCT exam for lymphoproliferative and/or neoplastic screening, were included in the study. Demographic, clinical, biological and serological data were collected. PI-US was performed by a single operator using a MyLab ClassC (Esaote), 13-18 MHz, 5 cm linear probe. PI was defined as the loss of normal hyperechoic linear pleural contour (score 0-2: normal, minimal and major changes at each intercostal space). PI-US total score represented the sum of partial scores assigned to 6 lung fields (2 for the anterior, 2 for postero-superior and 2 for postero-inferior chest surface). CT-abnormal findings, distinguishing typical (interstitial pattern) from atypical lung alterations (non specific findings), were analyzed by an expert radiologist. <h3>Results:</h3> 24 pSS patients (AECG criteria), 20 F:4 M, mean age =58 ±12.2 yrs, mean follow-up duration 8.6±12.2 yrs, were included in the study. All patients were positive for ANA, 21/24 for anti-Ro/SSA, 15/24 for Rheumatoid Factor (RF) and 6 of them for cryoglobulins. Four patients (16.67%) had a previous history of pSS-related lymphoproliferative disorder. None of the included patients reported cough or dyspnoea and the thoracic examination did not arise any abnormalities suggestive for lung disases. The mean PI-US total and postero-inferior partial score resulted 22.75±19.72 and 8.29±8.60 respectively. CT/HRCT resulted normal in 9/24 patients (37.5%) and showed abnormal findings in 15/24 (62.5%). The latter consisted of non- Interstitial Lung Disease (ILD) alterations in 13/15 cases (i.e 13/13 fibrotic striae and/or micro/macronodularities, 5/13 disventilatory striae and/or medium lobe syndrome, 3/13 bronchiectasias and/or bronchioloectasias and 3/13 thin-walled cysts/atypical emphysema). In 2/15 patients a new diagnosis of Interstitial Lung Disease (ILD) was made with patients presenting a typical NSIP-pattern. Both the mean PI-US total score and the postero-inferior partial score resulted significantly higher in patients with abnormal CT/HRCT compared to those with normal CT findings (p =0.003 and p= 0.001 respectively). On the contrary, PI-US total and partial scores were not significantly different between ILD and non-ILD pSS patients (p= 0.103). Conclusion: this study highlights the potential usefulness of PI-US as a sensitive, non invasive tool for the diagnosis of sub-clinical early lung alterations in pSS. <h3>Disclosure of Interests:</h3> Francesco Ferro: None declared, Alessandra Bulleri: None declared, Elena Elefante: None declared, Alessandra Tripoli: None declared, Marta Mosca Paid instructor for: GlaxoSmithKline, Lilly, UCB, Chiara Baldini: None declared