AB1330 A preliminary study on the baseline hrct scoring criteria for predicting the fibrosis progression of ra-ild
Authors: L. Li
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Interstitial lung disease (ILD) is the most common pulmonary manifestation of RA. The progression of fibrosis in RA-ILD varied differently, and effective predictors of progression were absent. <h3>Objectives</h3> To explore the baseline HRCT scoring criteria that can predict progressive fibrosis and provide reference for clinical diagnosis and treatment. <h3>Methods</h3> The chest HRCT of RA-ILD patients from 2009 to 2017 were retrospectively analysed, including 102 patients with progressive fibrosis and 50 patients without progressive fibrosis. Progressive fibrosis was defined as honeycombing development or an increase in extent of reticulation on follow-up HRCT. The baseline HRCT evaluation was performed by two thoracic radiologists blinded to all patient data, which including routine interstitial lesion evaluation and fibrosis predictive score. We proposed the baseline HRCT fibrosis predictive score to differentiate progressive fibrosis from the stable patients. The score included two parts, subpleural lesion score and bronchovascular bundle thickening score, with a total score of 0–9 points. <h3>Results</h3> In the routine evaluation, peripheral distribution was more common in the progressive fibrosis group (78.43% VS 52%, p&lt;0.05), traction bronchiectasis and traction bronchiolectasis both were more common in the progressive group (41.18% VS 8%, p&lt;0.01;93.14% VS 46%, p&lt;0.01; respectively). Compared with non-progressive fibrosis group, subpleural reticulation and subpleural linear opacities were more common in the progressive fibrosis group (79.21% VS 28%, p&lt;0.0; 41.80% VS 14%, p&lt;0.01; respectively), subpleural honeycombing was more common in the progressive fibrosis group (41.17% VS 20%, p&lt;0.05), subpleural ground-glass opacity showed no difference between the two groups (52.94% VS 66%, p&gt;0.05). Notably, subpleural honeycombing in the progressive group were all accompanied by the presence of subpleural reticulation and subpleural linear opacities on baseline HRCT. The AUC curve of fibrosis predictive score was 0.87 (95% confidence interval, 0.81, 0.93), indicating that baseline HRCT score had a better judgement value for progressive fibrosis. The cut-off value was 5.5 points (sensitivity was 64%, specificity 94%), that is, baseline HRCT score ≥6 points was more likely to develop progressive fibrosis. Drug interventions (glucocorticoids, cyclophosphamide) were relatively deficient in the progressive fibrosis group, (26.47% VS 44%, p&lt;0.05; 9.80% VS 22%, p&lt;0.05; respectively). Further analysis showed that treatment situations (glucocorticoids, cyclophosphamide) were similar between the baseline HRCT score ≥6 points group and the baseline HRCT score &lt;6 points group (34.78% VS 30.12%, p&gt;0.05; 10.14% VS 16.87%, p&gt;0.05; respectively), suggesting that patients with potential fibrotic tendencies had not been treated actively in the early stage. <h3>Conclusions</h3> The baseline HRCT score has a better predictive value for the progressive fibrosis of RA-ILD, traction bronchiectasis and traction bronchiolectasis are helpful to identify progression. The baseline HRCT evaluation may provide a reference for the choice of time for treatment. <h3>Disclosure of Interest</h3> None declared