Radiation-free screening can identify interstitial lung involvement in rheumatoid arthritis

For asymptomatic rheumatoid arthritis (RA) patients, a new radiation-free screening protocol can identify suspected interstitial lung involvement (ILI), according to a study published online Nov. 23 in BMC Pulmonary Medicine.

Frank Reichenberger, M.D., from Augustinum Hospital Munich, and colleagues proposed a noninvasive, radiation-free approach to ILI screening using pulmonary function tests (PFT) and pleuro-pulmonary transthoracic ultrasound (LUS) with additional cardiopulmonary exercise tests with electrocardiography and echocardiography.

The study included 67 consecutive patients with a confirmed diagnosis of seropositive RA, without symptoms for or known cardiovascular disease. When significant LUS abnormalities and additional PFT changes were present, interstitial lung disease (ILD) was suspected.

The researchers found that 40% of patients had noticeable changes in LUS, 24% with a pattern compatible with ILD. LUS abnormalities and additional PFT changes were present in 16% of cases, and ILI was suspected. Obstructive lung disease; subpleural consolidation, including one confirmed lung cancer; minimal pleural effusion; and ischemic cardiac disease were included as additional findings (11, six, six, and two patients, respectively). Pulmonary vascular involvement was not seen in any of the patients.

“Our study supports the growing evidence and experience in using LUS for screening for RA-ILD,” the authors write. “We propose LUS as an appropriate imaging tool in combination with PFT for ILD screening in RA.”

More information:
Frank Reichenberger et al, Proposal of a radiation-free screening protocol for early detection of interstitial lung involvement in seropositive and ACPA-positive rheumatoid arthritis, BMC Pulmonary Medicine (2024). DOI: 10.1186/s12890-024-03405-y

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