Edith Schneeberger Emilce, Miguel Perandones, Gabriel Rosemffet Marcos, María Otaola, Tomás Cazenave, Tatiana Barbich, Virginia Carrizo Abarza, Jonathan Balcazar, Gustavo Citera
Rheumatology Section, Instituto de Rehabilitación Psicofísica (IREP), Buenos Aires, Argentina.
Pulmonology Section, Instituto de Rehabilitación Psicofísica (IREP), Buenos Aires, Argentina.
Clin Rheumatol. 2025 Jun 24. doi: 10.1007/s10067-025-07510-z.
UNLABELLED: The best screening way to detect interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA) is still debated. OBJECTIVES: To evaluate the performance of scores to identify patients with ILD in patients with RA. METHODS: Cross-sectional study, adult outpatients with RA were included and those with any disease that can affect lung ultrasonography (LUS) evaluation were excluded. Sociodemographic, clinical, and therapeutic variables were recorded. All patients underwent chest x-rays, pulmonary function tests (PFT), LUS, and high-resolution chest tomography (HRCT). Univariate and multivariate analyses and ROC curves. RESULTS: 107 patients with RA, median age of 62 years (IQR 36-84), 82.2% female, and median disease duration 14 years (IQR 1-42). A total of 30 patients (29.5%) had ILD by HRCT. The classic cutoff value of ≥ 5 B lines in the LUS (ILD by HRCT as the gold standard) showed an AUC of 0.86 (95% CI 0.78-0.94), Se 87.1%, and Sp 74.3% for the detection of ILD. A clinical score made up of 5 variables to identify the presence of ILD, based on the strength of association in the multivariate analysis: male sex, crackles, age ≥ 60 years, RF + , anti-CCP + . Range 0-11, cutoff value ≥ 5.5, AUC 0.80 (95% CI 0.70-0.89), Se 75%, and Sp 71%. When we added the LUS variable to this score: lines B ≥ 5, the range was 0-15, a cutoff value ≥ 7.5, AUC 0.88 (95% CI 0.81-0.94), Se improved to 84.4%, and Sp 75%. However, this last score did not exceed the performance of isolated LUS. CONCLUSIONS: LUS is a good tool for detecting ILD in patients with RA. Key Points • Interstitial lung disease (ILD) is an extra-musculoskeletal manifestation with high morbidity and mortality in patients with rheumatoid arthritis (RA). Early detection could improve the prognosis of these patients. • High-resolution chest tomography (HRCT) is the gold standard for ILD diagnosis, but high radiation and limited access hinder its use. • Lung ultrasound (LUS) is an excellent tool for detecting ILD in RA patients and performs better than clinical scores. • LUS provides a method of screening for ILD in patients with RA in a simple, cheap, safe, and effective way.
未标注：类风湿关节炎（RA）患者中检测间质性肺疾病（ILD）的最佳筛查方法仍存在争议。 目的：评估用于识别RA患者中ILD患者的评分的性能。 方法：横断面研究，纳入成年RA门诊患者，排除任何可影响肺部超声（LUS）评估的疾病患者。记录社会人口统计学、临床和治疗变量。所有患者均接受胸部X线、肺功能测试（PFT）、LUS和高分辨率胸部断层扫描（HRCT）。进行单变量和多变量分析以及ROC曲线分析。 结果：107例RA患者，中位年龄62岁（四分位间距36 - 84岁），82.2%为女性，中位病程14年（四分位间距1 - 42年）。共有30例（29.5%）患者经HRCT诊断为ILD。以HRCT诊断ILD为金标准，LUS中经典的≥5条B线截断值检测ILD的曲线下面积（AUC）为0.86（95%置信区间0.78 - 0.94），敏感度（Se）为87.1%，特异度（Sp）为74.3%。基于多变量分析中的关联强度，由5个变量组成的临床评分用于识别ILD的存在：男性、湿啰音、年龄≥60岁、类风湿因子阳性（RF +）、抗环瓜氨酸肽抗体阳性（anti - CCP +）。范围为0 - 11，截断值≥5.5，AUC为0.80（95%置信区间0.70 - 0.89），Se为75%，Sp为71%。当我们将LUS变量（B线≥5）添加到该评分中时，范围为0 - 15，截断值≥7.5，AUC为0.88（95%置信区间0.81 - 0.94），Se提高到84.4%，Sp为75%。然而，最后这个评分的性能未超过单独LUS的性能。 结论：LUS是检测RA患者中ILD的良好工具。要点•间质性肺疾病（ILD）是类风湿关节炎（RA）患者的一种肌肉骨骼外表现，发病率和死亡率高。早期检测可改善这些患者的预后。•高分辨率胸部断层扫描（HRCT）是ILD诊断的金标准，但高辐射和可及性有限阻碍了其应用。•肺部超声（LUS）是检测RA患者中ILD的优秀工具，且性能优于临床评分。•LUS以简单、廉价、安全和有效的方式为RA患者提供了一种ILD筛查方法。
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