AB0601 VALUE OF LUNG ULTRASONOGRAPHY TO DETECT INTERSTITIAL LUNG DISEASE IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: M. Perandones, E. E. Schneeberger, M. Rosemffet, T. Barbich, T. Cazenave, V. Carrizo Abarza, M. Otaola, J. Balcazar, G. Citera
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Interstitial lung disease (ILD) in rheumatoid arthritis (RA) is an extra-musculoskeletal manifestation with high mortality. Early detection could improve the quality of life of these patients. High-resolution chest tomography (HRCT) is the diagnostic method of choice, but the high radiation limits its use. Different clinical, laboratory, genetic and ultrasonographic parameters have been proposed for the detection of this condition. <h3>Objectives:</h3> Identify sociodemographic and clinical variables associated with the presence of ILD in patients with RA, evaluate the performance of a clinical score and a clinical score combined with pulmonary ultrasonography (PU) versus PU alone to identify patients with ILD. <h3>Methods:</h3> Outpatients ≥18 years of age, with a diagnosis of RA according to ACR/EULAR 2010 criteria, were evaluated. Patients with other decompensated lung and/or heart disease were excluded. Sociodemographic, clinical, therapeutic variables, respiratory signs and symptoms (cough, dyspnea, crackles) and smoking habit were recorded. Positivity for RF and anti-CCP was recorded. Disease activity (DAS28), functional capacity (HAQ-A) and quality of life (QOLRA II) were evaluated. All patients underwent chest x-ray, functional respiratory examination with DLCO, PU with evaluation of 14 areas (number of B lines and number of pleural irregularities) and HRCT. Univariate and multivariate analysis, ROC curves <h3>Results:</h3> 107 patients were included with a median age (<i>m</i>) of 62 years (IQR 36-84), 82.2% female and RA evolution time <i>m</i> 14 years (IQR 1-42). A total of 30 patients (29.5%) had ILD due to HRCT and 48 patients (45.8%) due to PU. The classic cut-off value of ≥5 B lines in PU (using the presence of ILD by HRCT as the gold standard), showed an AUC 0.86 (95% CI 0.78-0.94), an Sensitivity 87.1% and an Specificity 74.3%. We developed a clinical score made up of 5 variables to identify the presence of ILD, based on the strength of association in the multivariate analysis (odds ratio): male sex (3 points), crackles (3 points), age ≥ 60 years (2 points), RF + (2 points), anti-CCP + (1 point). Range 0-11, cut-off value ≥5.5, AUC 0.80 (95% CI 0.70-0.89), Sensitivity 75% and Specificity 71%. When we added the PU variable to this score: B lines ≥5 (4 points), the range was 0-15, a cut-off value ≥7.3, AUC 0.88 (95% CI 0.81-0.94) improves the Sensitivity 84.4% and Specificity 75%. However, this last score did not exceed the performance of the isolated PU. <h3>Conclusion:</h3> The PU was the best tool for the detection of ILD in patients with RA. <h3>REFERENCES:</h3> <b>NIL.</b> Classic cut-off value of ≥5 B lines in PU. ROC curves AUC 0.86 (95% CI 0.78-0.94), an Sensitivity 87.1% and an Specificity 74.3%. Clinical score combined with pulmonary ultrasonography (PU) Range was 0-15, a cut-off value ≥7.3, AUC 0.88 (95% CI 0.81-0.94). Sensitivity 84.4% and Specificity 75%. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Miguel Perandones Pfizer, Emilce Edith Schneeberger Pfizer, Marcos Rosemffet Pfizer, Tatiana Barbich Pfizer, Tomás Cazenave Pfizer, Virginia Carrizo Abarza Pfizer, Maria Otaola Pfizer, Jonathan Balcazar Pfizer, Gustavo Citera Pfizer.