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The following is a summary of “Proposal of a radiation-free screening protocol for early detection of interstitial lung involvement in seropositive and ACPA-positive rheumatoid arthritis,” published in the November 2024 issue of Pulmonology by Reichenberger et al. 

Seropositive rheumatoid arthritis (RA) is linked to notable cardiovascular and pulmonary complications, yet there is no established screening protocol for early detection of pulmonary involvement, particularly interstitial lung disease (ILD) in RA.  

Researchers conducted a retrospective study to propose a non-invasive, radiation-free screening approach for interstitial lung involvement (ILI) in seropositive RA using pulmonary function tests (PFT) pleuro-pulmonary transthoracic ultrasound (LUS), cardiopulmonary exercise tests (CPET) with ECG, and echocardiography.  

They screened RA patients for ILI in seropositive, which included PFT, LUS, CPET with ECG, and echocardiography. The study involved patients diagnosed with seropositive RA according to American College of Rheumatology (ACR) criteria, without symptoms or known cardiopulmonary disease, ILD was suspected when significant abnormalities in LUS and changes in PFT were observed.  

The results showed that 67 consecutive patients (78% female, mean age 61 ± 12 years, 48% active or former smokers) were included. Among them, 48% exhibited suspected PFT changes, with 7% having forced vital capacity (FVC) ≤ 80% and 48% showing a diffusion capacity (DLCOc-SB) ≤ 80%, 40% of patients had LUS changes, with 24% displaying an ILD-compatible pattern. In 16% of cases, LUS and PFT abnormalities indicated suspected ILI. Additional findings included obstructive lung disease (n = 11), subpleural consolidation (n = 6, including one confirmed lung cancer), minimal pleural effusion (n = 6), and ischemic cardiac disease (n = 2). No signs of pulmonary vascular involvement were observed.   

Investigators concluded that a new radiation-free screening protocol suspected ILI in 16% of asymptomatic patients with RA.   

Source: bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-024-03405-y