Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Servicio de Reumatología, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain.
Reumatol Clin (Engl Ed). 2022 Dec;18(10):587-596. doi: 10.1016/j.reumae.2021.07.002. Epub 2021 Nov 11.
Interstitial lung disease (ILD) is frequent in patients with rheumatoid arthritis (RA) and is associated with significant morbidity and mortality. The aim of this review was to identify the different screening methods for ILD in patients with RA.
We ran a systematic search in Pubmed, Embase and Cochrane Library up to April 2020 and did a hand search of the references of the retrieved articles. The search was limited to humans and articles published in English, Spanish or French. We selected studies with any design where: (a) the population included adult patients with RA; (b) the intervention was any screening method for ILD; and (c) validity or reliability of the screening method were evaluated, or a screening method was described. Two reviewers independently screened the articles by title and abstract and subsequently extracted the information using a specific data extraction form.
25 studies were included with a total of 2593 patients. The most frequently used tool for ILD screening was high resolution computed tomography (HRCT) of the lung. Electronic auscultation, biochemical markers, bronchoalveolar lavage (BAL), pulmonary function tests (PFTs) and lung ultrasonography were also evaluated. Across the different studies, electronic auscultation and lung ultrasonography achieved higher accuracy than PFTs, BAL and biochemical markers.
HRCT resulted as the most sensitive tool for ILD screening in patients with RA. Given its harmlessness and high sensitivity, lung ultrasonography may become the first-choice tool in the future.
间质性肺疾病（ILD）在类风湿关节炎（RA）患者中较为常见，与较高的发病率和死亡率相关。本综述旨在确定 RA 患者ILD 的不同筛查方法。
我们在 Pubmed、Embase 和 Cochrane Library 中进行了系统性检索，检索截至 2020 年 4 月，并对检索到的文章的参考文献进行了手工检索。检索仅限于人类和以英语、西班牙语或法语发表的文章。我们选择了任何设计的研究，其中：（a）人群包括成年 RA 患者；（b）干预措施为ILD 的任何筛查方法；（c）评估了筛查方法的有效性或可靠性，或描述了一种筛查方法。两名审查员独立筛选标题和摘要，并使用特定的数据提取表提取信息。
共纳入 25 项研究，总计 2593 例患者。ILD 筛查最常用的工具是肺部高分辨率计算机断层扫描（HRCT）。电子听诊、生化标志物、支气管肺泡灌洗（BAL）、肺功能检查（PFTs）和肺部超声也进行了评估。在不同的研究中，电子听诊和肺部超声的准确性均高于 PFTs、BAL 和生化标志物。
HRCT 是 RA 患者ILD 筛查最敏感的工具。鉴于其无害性和高灵敏度，肺部超声可能成为未来的首选工具。
