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Utility of pulmonary ultrasound to identify interstitial lung disease in patients with rheumatoid arthritis

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A Correction to this article was published on 18 April 2021

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Abstract

Objectives

To analyze the diagnostic utility of lung ultrasound (US) to detect interstitial lung disease (ILD) in rheumatoid arthritis (RA) patients comparing with high-resolution computed tomography (HRCT)

Patients and methods

We performed a cross-sectional, observational study in patients with RA-ILD (cases) controlled with a group of RA patients without ILD (controls) paired by sex, age, and time of disease evolution. Patients were assessed using HRCT, PFT, and US. The main variables were B-line number, evaluation of the lung-US score already described, pleural irregularities, and A pattern US lost. ROC curve analysis was performed to establish the cut-off point of the US B-lines number for detecting the presence of significant RA–ILD in relation to HRCT, and logistic regression analysis was performed to identify the intercostal spaces.

Results

Seventy-one patients were included, 35 (49.2%) with ILD-RA and 36 (50.8%) RA controls. Regarding US score, we found that the detection of 5.5 lines in a reduced score of 8 intercostal spaces had a sensitivity = 62.2%, specificity = 91.3%, PPV = 88.4%, and NPV = 69.5%. In multivariate analysis, the intercostal spaces which showed independent association with ILD were 3rd right anterior axillary space (OR [IC 95%] 19.0 [1.3–27.5]), 8th right posterior axillary space (OR [IC 95%] 0.04 [0.0–0.6]), 8th right subscapular space (OR [IC 95%] 16.5 [1.8–45.5]), 9th right paravertebral space (OR [IC 95%] 7.11 [1.0–37.1]), and 2nd left clavicular middle space (OR [IC 95%] 21.9 [1.26–37.8]).

Conclusions

Lung ultrasound could be a useful tool for ILD diagnosis associated with rheumatoid arthritis. A 8-space reduced score showed a similar total predictive capacity than 72-space score.

Key Points

• Lung ultrasound could be a useful tool for ILD diagnosis associated with rheumatoid arthritis.

• The 72-space evaluation is highly sensitive, whereas a simplified score enables a more specific and faster diagnosis.

• The number of B lines is correlated with DLCO, ACPA, inflammatory activity, and physical function.

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Acknowledgements

To the Spanish Rheumatology Society (SER) for the translation of the manuscript.

Funding

Grant for Medical Researchers of the “Fundación Española de Reumatología” 2019.

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Authors and Affiliations

  1. Instituto de Investigación Biomédica de Málaga (IBIMA), 29010, Málaga, Spain

    Natalia Mena-Vázquez, Francisco Gabriel Jimenez-Núñez, Francisco Javier Godoy-Navarrete, Sara Manrique-Arija, Inmaculada Ureña-Garnica & Antonio Fernández-Nebro

  2. UGC de Reumatología, Hospital Regional Universitario de Málaga, Plaza del Hospital Civil s/n., 29009, Málaga, Spain

    Natalia Mena-Vázquez, Francisco Gabriel Jimenez-Núñez, Francisco Javier Godoy-Navarrete, Sara Manrique-Arija, Inmaculada Ureña-Garnica & Antonio Fernández-Nebro

  3. UGC de Radiodiagnóstico, Hospital Regional Universitario de Málaga, 29009, Málaga, Spain

    María Carmen Aguilar-Hurtado & María Isabel Padin-Martín

  4. UGC de Reumatología, Hospital Clínico Universitario Virgen de la Victoria, 29010, Málaga, Spain

    Carmen María Romero-Barco

  5. UGC de Neumología, Hospital Regional Universitario de Málaga, 29009, Málaga, Spain

    F. Espildora

  6. Departamento de Medicina, Universidad de Málaga, Málaga, Spain

    Antonio Fernández-Nebro

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  1. Natalia Mena-Vázquez
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  2. Francisco Gabriel Jimenez-Núñez
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Contributions

NMV participated in the design of the study, carried out patient recruitment and statistical analysis, and drafted the manuscript. FGJN, FJGN, and SMA were a contributor in including patients. They were a major contributor in writing the manuscript and they were a contributor in analyzing and interpreting the patient data. MCAH and MIPM collected radiology data and FGJM in pulmonary ultrasound data. IUG, MCRB, and FE were a major contributor in including patients. AFN: a contributor in writing the manuscript. He was a contributor in analyzing and interpreting the patient data. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Natalia Mena-Vázquez or Francisco Gabriel Jimenez-Núñez.

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None.

Ethics approval and consent to participate

All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of Málaga (“Comité de Ética de la Investigación de Málaga”) (Project identification Code 1549-N-19).

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In the original published version of this article under the Result and Conclusion sections of the “Abstract” contained errors and has been corrected above with the following updates: 1. Result: 35 (49.2%) with ILD-RA and 36 (50.8%) RA controls.; 8 intercostal spaces. 2. Conclusions: 8-space reduced.

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Mena-Vázquez, N., Jimenez-Núñez, F.G., Godoy-Navarrete, F.J. et al. Utility of pulmonary ultrasound to identify interstitial lung disease in patients with rheumatoid arthritis. Clin Rheumatol 40, 2377–2385 (2021). https://doi.org/10.1007/s10067-021-05655-1

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  • DOI: https://doi.org/10.1007/s10067-021-05655-1

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