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Hannah J, Rodziewicz M, Mehta P, Heenan KM, Ball E, Barratt S, Carty S, Conway R, Cotton CV, Cox S, Crawshaw A, Dawson J, Desai S, Fahim A, Fielding C, Garton M, George PM, Gunawardena H, Kelly C, Khan F, Koduri G, Morris H, Naqvi M, Perry E, Riddell C, Sieiro Santos C, Spencer LG, Chaudhuri N, Nisar MK. The diagnosis and management of systemic autoimmune rheumatic disease-related interstitial lung disease: British Society for Rheumatology guideline scope. Rheumatol Adv Pract 2024; 8:rkae056. [PMID: 38765189 PMCID: PMC11101284 DOI: 10.1093/rap/rkae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/12/2024] [Indexed: 05/21/2024] Open
Abstract
Interstitial lung disease (ILD) is a significant complication of many systemic autoimmune rheumatic diseases (SARDs), although the clinical presentation, severity and outlook may vary widely between individuals. Despite the prevalence, there are no specific guidelines addressing the issue of screening, diagnosis and management of ILD across this diverse group. Guidelines from the ACR and EULAR are expected, but there is a need for UK-specific guidelines that consider the framework of the UK National Health Service, local licensing and funding strategies. This article outlines the intended scope for the British Society for Rheumatology guideline on the diagnosis and management of SARD-ILD developed by the guideline working group. It specifically identifies the SARDs for consideration, alongside the overarching principles for which systematic review will be conducted. Expert consensus will be produced based on the most up-to-date available evidence for inclusion within the final guideline. Key issues to be addressed include recommendations for screening of ILD, identifying the methodology and frequency of monitoring and pharmacological and non-pharmacological management. The guideline will be developed according to methods and processes outlined in Creating Clinical Guidelines: British Society for Rheumatology Protocol version 5.1.
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Affiliation(s)
- Jennifer Hannah
- Academic Rheumatology, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Mia Rodziewicz
- Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Puja Mehta
- Centre for Inflammation and Tissue Repair, University College London, London, UK
| | - Kerri-Marie Heenan
- Department of Respiratory Medicine, Northern Health and Social Care Trust, Antrim, UK
| | - Elizabeth Ball
- Department of Rheumatology, Belfast Health and Social Care Trust, Belfast, UK
| | - Shaney Barratt
- Department of Respiratory Medicine, Bristol Medical School, Bristol, UK
| | - Sara Carty
- Department of Rheumatology, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Richard Conway
- Department of Rheumatology, Trinity College Dublin, Dublin, Ireland
| | - Caroline V Cotton
- Department of Rheumatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Anjali Crawshaw
- Department of Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Julie Dawson
- Department of Rheumatology, St Helens Hospital, Saint Helens, UK
| | - Sujal Desai
- Radiology Department, Royal Brompton Hospital, London, UK
| | - Ahmed Fahim
- Department of Respiratory Medicine, New Cross Hospital, Wolverhampton, UK
| | | | - Mark Garton
- Department of Rheumatology, Royal Shrewsbury Hospital, Shrewsbury, UK
| | - Peter M George
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | | | - Clive Kelly
- Department of Rheumatology, James Cook University Hospital, Middlesbrough, UK
| | - Fasihul Khan
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Gouri Koduri
- Department of Rheumatology, Southend University Hospital NHS Foundation Trust, Southend-on-Sea, Essex, UK
| | - Helen Morris
- Department of Respiratory Medicine, Wythenshawe Hospital, Manchester, UK
| | - Marium Naqvi
- Department of Respiratory Medicine, Guy’s and St Thomas’ Hospitals NHS Trust, London, UK
| | - Elizabeth Perry
- Department of Rheumatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Claire Riddell
- Department of Rheumatology, Belfast Health and Social Care Trust, Belfast, UK
| | | | - Lisa G Spencer
- Department of Respiratory Medicine, Aintree University Hospital, Liverpool, UK
| | | | - Muhammad K Nisar
- Rheumatology Department, Luton, Dunstable University Hospital, Luton, UK
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Ozsoy Z, Ayan G, Durhan G, Kalyoncu U. Apical fibrobullous lung disease in spondyloarthritis patients with biologic DMARDs indication. Rheumatology (Oxford) 2024; 63:1147-1152. [PMID: 37498613 PMCID: PMC10986796 DOI: 10.1093/rheumatology/kead361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/12/2023] [Accepted: 07/03/2023] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE The rate of pleuroparenchymal involvement in patients with SpA varies widely, from 0% to 85%. The most common form is apical fibrobullous disease (AFLD). The aim of this study was to determine the incidence of AFLD and associated factors in SpA patients under and/or planned to start biologic DMARDs (bDMARDs) therapy. METHODS The records of 3021 SPA patients registered with HUR-BIO who had indication of bDMARDs between 2010 and 2021 were scanned. The study included 2489 patients with at least one chest radiograph (X-ray). Patient demographics, comorbidities, laboratory data, bDMARDs used, baseline DASs, and purified protein derivative and/or QuantiFERON test results before initiation of bDMARDs were recorded. RESULTS Of the 2489 patients, 36 (1.4%) were found to have AFLD by X-ray and/or CT. The mean disease duration was 11.7 (7.1) years. Patients with AFLD were more likely to be male [28 (77.8%) vs 1321 (53.9%), P = 0.004], older [56.3 (10.5) years vs 44.8 (11.4) years, P < 0.001], heavy smokers [27 (79.4%) vs 1468 (60.9%), P = 0.028] and have had longer disease duration [17. 7 (9.7) years vs 11.6 (7) years, P = 0.001]. QuantiFERON positivity was higher in the AFLD group [9 (36%) vs 309 (16.1%), P = 0.013]. While treatment with adalimumab was less preferred in those with AFLD, treatment with etanercept was more frequently preferred. CONCLUSION As the radiological findings of AFLD can be confused with those of tuberculosis, special attention should be paid to differentiating between tuberculosis and the disease in males and in patients who have had long disease duration.
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Affiliation(s)
- Zehra Ozsoy
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - Gizem Ayan
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - Gamze Durhan
- Faculty of Medicine, Department of Radiology, Hacettepe University, Ankara, Turkey
| | - Umut Kalyoncu
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
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Ahmed EA, Atar S, Atar Y, Sari H, Anarat MEA, Saltürk Z, Karaketir SG, Uyar Y, Kuru Ö. Evaluation of the Swallowing and Voice Functions in Ankylosing Spondylitis Patients. Dysphagia 2021; 37:455-462. [PMID: 34259915 DOI: 10.1007/s00455-021-10340-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 07/08/2021] [Indexed: 11/26/2022]
Abstract
This study aimed to evaluate the swallowing and voice functions in patients with ankylosing spondylitis. Thirty patients with ankylosing spondylitis (Group 1) and 30 healthy individuals (Group 2) were included in the study. Following the laryngoscopic evaluation of the patients, the fiberoptic endoscopic evaluation of swallowing was performed, and then, the penetration-aspiration score was determined. The participants were asked to fill the eating assessment tool form. Voice recordings obtained to evaluate sound disorders were measured acoustically and analyzed using the PRAAT program. In terms of swallowing, the penetration-aspiration score obtained as a result of the flexible endoscopic swallowing assessment and eating assessment tool score was found to be higher in Group 1 than in Group 2, and a statistically significant difference was noted (p ≤ 0.001). When analyzing the maximum phonation time (p < 0.001) and fundamental frequency (p = 0.408) values in phonation evaluation, a statistically significant difference was found between the two groups. Group 1 showed a deterioration in terms of jitter (p = 0.040) and shimmer (p = 0.007) compared to Group 2, and a statistically significant difference was noted. There was no statistically significant difference in the harmonic/noise ratio (mean ± standard deviation) between the two groups (p = 0.051). Swallowing and voice functions significantly affect quality of life. Therefore, approaches aimed to improve the associated symptoms have become increasingly important. In patients with ankylosing spondylitis, swallowing quality and phonation ability may be negatively affected. These patients should be monitored for hidden or overt food aspiration.Trial Registry: https://clinicaltrials.gov/ct2/show/NCT04437394.
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Affiliation(s)
| | - Sevgi Atar
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Darulaceze Cad. No: 25 Okmeydani-Sisli, Istanbul, Turkey.
| | - Yavuz Atar
- Department of Otorhinolaryngology, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Hüseyin Sari
- Department of Otorhinolaryngology, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Melis Ece Arkan Anarat
- Department of Otorhinolaryngology, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Ziya Saltürk
- Department of Otorhinolaryngology, Anadolu Medical Center, In Affiliation With Johns Hopkins Medicine, Istanbul, Turkey
| | | | - Yavuz Uyar
- Department of Otorhinolaryngology, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Ömer Kuru
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Darulaceze Cad. No: 25 Okmeydani-Sisli, Istanbul, Turkey
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Rapidly Progressive Pulmonary Apical Fibrosis and Parenchymal Destruction in a Patient with Ankylosing Spondylitis. Case Rep Rheumatol 2020; 2020:8852515. [PMID: 33014502 PMCID: PMC7512063 DOI: 10.1155/2020/8852515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 11/30/2022] Open
Abstract
Pulmonary apical fibrosis is a rare complication of ankylosing spondylitis (AS). The essential characteristics of this lesion are its very slow progression and frequently asymptomatic nature. Herein, we are presenting a patient with AS who rapidly developed pulmonary apical fibrosis in a 3-year period despite decreased musculoskeletal pains. The 60-year-old male applied with complaints of progressively increasing cough in the recent two years, dyspnea, and fatigue. He had no chronic disease except AS. He had no continuous medication except nonsteroid anti-inflammatory drugs for 2-3 days monthly since his musculoskeletal pains decreased in the recent years. His physical examination revealed reduced breath sounds in the upper zones of the right lung. Chest X-ray revealed increased diffuse opacity in the upper zones of the right lung. Thoracic high-resolution computed tomography showed a consolidation accompanied with traction bronchiectases compatible with chronic fibrosis in the upper lobe of the right lung. However, thoracic computed tomography of the patient performed 3 years ago did not reveal pulmonary apical fibrosis and parenchymal destruction. Biopsy revealed no finding of malignancy, granulomatous inflammation, or vasculitis. The results of cultures were negative. So, the patient was diagnosed as pulmonary involvement of AS, which developed in a 3-year period. This case has shown that extra-articular complications may continue to develop in patients with AS even if their musculoskeletal complaints have subsided. So, patients with AS should be followed up regularly with systemic examinations.
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Fitzgerald G, Gallagher P, O’Shea FD. Multimorbidity in Axial Spondyloarthropathy and Its Association with Disease Outcomes: Results from the Ankylosing Spondylitis Registry of Ireland Cohort. J Rheumatol 2019; 47:218-226. [DOI: 10.3899/jrheum.181415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
Objective.Multimorbidity, the coexistence of 2 or more conditions in an individual, is associated with morbidity and mortality in the general population. This study aims to describe the prevalence of multimorbidity in axial spondyloarthropathy (axSpA) and assess its association with disease outcome measures.Methods.This cross-sectional study was conducted within the Ankylosing Spondylitis Registry of Ireland (ASRI) cohort. Structured standardized assessment was performed. Multimorbidity was considered as the presence of at least 1 physician-diagnosed chronic condition (excluding extraarticular manifestations) in addition to axSpA. Validated outcome measures were collected: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Health Assessment Questionnaire (HAQ), AS Quality of Life (ASQoL), and Bath AS Metrology Index (BASMI). Adjusted multiple regression was performed to investigate the association between multimorbidity and disease outcomes.Results.A total of 734 patients from 12 centers were included: 77% male, mean (SD) age 45 (12) years. Of the cohort, 55% (n = 403) were multimorbid. Multimorbid patients were significantly (p < 0.01) older than axSpA-only patients [50 (12) vs 40 (11) yrs]. Obesity was the most prevalent chronic condition, affecting 27%. Multimorbid patients had more severe disease than patients with axSpA only. After adjusting for confounders, multimorbidity was associated with higher BASDAI (ß 0.7, 95% CI 0.34–1.05), BASMI (ß 0.45, 95% CI 0.09–0.80), BASFI (ß 0.5, 95% CI 0.23–0.78), HAQ (ß 0.07, 95% CI 0.00–0.13), and ASQoL (ß 0.87, 95% CI 0.28–1.46).Conclusion.Multimorbidity is prevalent in axSpA and is associated with more severe disease.
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Bergman M, Lundholm A. Managing morbidity and treatment-related toxicity in patients with ankylosing spondylitis. Rheumatology (Oxford) 2018; 57:419-428. [PMID: 28977661 PMCID: PMC5850804 DOI: 10.1093/rheumatology/kex292] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Indexed: 12/17/2022] Open
Abstract
AS is the prototypical member of the family of spondyloarthropathies, and is characterized by seronegativity, axial predominance and new bone formation, which underlie symptoms of inflammatory back pain, enthesopathy and extra-articular manifestations, including anterior uveitis, psoriasis and colitis. Patients with AS typically experience a wide variety of morbidities. These include both morbidities related to the disease itself—most prominently progressive, irreversible, structural damage to the axial or peripheral skeleton—and morbidities stemming from treatments for the disease, including toxicities from NSAID use, and increased risk of infections and immunogenicity concerns with biologics. AS is also associated with a number of comorbidities. We review the risks associated with AS, its comorbidities and its treatments, as well as strategies that can be used to mitigate these risks in patients with AS.
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Affiliation(s)
- Martin Bergman
- Department of Medicine, Drexel University College of Medicine, PA, USA
| | - Amy Lundholm
- Rheumatology, Lankenau Medical Center, Wynnewood, PA, USA
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Karakose Okyaltırık F, Rezvani A, Turan S, Uysal Ö, Yakar F, Sozgen H, Ozkan NE, Akkoyunlu ME, Bayram M, Kutbay Ozcelik H, Sezer M, Guler M, Yaylım İ, Kart L. Relationship of CTLA4 and CD28 polymorphisms with lung involvement, HRCT findings and pulmonary function tests in Turkish patients with ankylosing spondylitis. CLINICAL RESPIRATORY JOURNAL 2015; 11:593-601. [DOI: 10.1111/crj.12388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 08/11/2015] [Accepted: 09/06/2015] [Indexed: 11/26/2022]
Affiliation(s)
| | - Aylin Rezvani
- Department of Physical Therapy and Rehabilitation; Bezmialem Vakif University; Istanbul Turkey
| | - Saime Turan
- Department of Molecular Medicine; Istanbul University, Institute for Experimental Medicine Research; Istanbul Turkey
| | - Ömer Uysal
- Department of Biostatistics and Medical Informatics; Bezmialem Vakif University; Istanbul Turkey
| | - Fatih Yakar
- Department of Chest Disease; Bezmialem Vakif University; Istanbul Turkey
| | - Hatice Sozgen
- Department of Chest Disease; Bezmialem Vakif University; Istanbul Turkey
| | - Nazlı Ezgi Ozkan
- Department of Molecular Medicine; Istanbul University, Institute for Experimental Medicine Research; Istanbul Turkey
| | | | - Mehmet Bayram
- Department of Chest Disease; Bezmialem Vakif University; Istanbul Turkey
| | | | - Murat Sezer
- Department of Chest Disease; Bezmialem Vakif University; Istanbul Turkey
| | - Mustafa Guler
- Department of Physical Therapy and Rehabilitation; Bezmialem Vakif University; Istanbul Turkey
| | - İlhan Yaylım
- Department of Molecular Medicine; Istanbul University, Institute for Experimental Medicine Research; Istanbul Turkey
| | - Levent Kart
- Department of Chest Disease; Bezmialem Vakif University; Istanbul Turkey
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Yuksekkaya R, Almus F, Celıkyay F, Celıkel S, Inanır A, Almus E, Ozmen Z. Pulmonary involvement in ankylosing spondylitis assessed by multidetector computed tomography. Pol J Radiol 2014; 79:156-63. [PMID: 24971158 PMCID: PMC4070990 DOI: 10.12659/pjr.889850] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 12/06/2013] [Indexed: 12/21/2022] Open
Abstract
Background Ankylosing spondylitis (AS) may present with extra-articular involvement in the lungs. We aimed to evaluate the abnormal pulmonary multidetector computed tomography findings of patients with AS and compare them with the clinical symptoms, duration of illness, laboratory results and pulmonary function tests (PFT). Material/Methods We evaluated the chest multidetector computed tomography (MDCT) findings of 41 patients with ankylosing spondylitis (AS) and compared them with pulmonary function test (PFT) results, demographic characteristics, duration of illness and laboratory findings that we were able to obtain. Results The most common abnormalities were nodules, peribronchial thickening, pleural thickening and bronchiectasis. Abnormalities occurred in 96.87% of patients in the early AS group and 77.8% of patients in the late AS group. Patients with early AS included asymptomatic individuals with normal PFT results and abnormal MDCT findings. Conclusions The use of MDCT in AS patients may be beneficial for the evaluation of pulmonary disease, even in asymptomatic patients without any PFT abnormalities and those in the early stages of the disease.
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Affiliation(s)
- Ruken Yuksekkaya
- Department of Radiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Ferdag Almus
- Department of Radiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Fatih Celıkyay
- Department of Radiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Serhat Celıkel
- Department of Chest Disease, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Ahmet Inanır
- Department of Radiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey ; Department of Physical Medicine and Rehabilitation, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Eda Almus
- Department of Radiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Zafer Ozmen
- Department of Radiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
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Hasiloglu ZI, Havan N, Rezvani A, Sariyildiz MA, Erdemli HE, Karacan I. Lung parenchymal changes in patients with ankylosing spondylitis. World J Radiol 2012; 4:215-9. [PMID: 22761981 PMCID: PMC3386533 DOI: 10.4329/wjr.v4.i5.215] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 04/01/2012] [Accepted: 04/08/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess lung parenchymal changes in ankylosing spondylitis (AS) using high resolution computed tomography (HRCT).
METHODS: We included 78 AS patients whose average age was 33.87 (18-56) years with a ratio of 53 males to 25 females who were followed up for 3.88 (1-22) years on average. Pneumonia and tuberculosis were excluded. In a detailed examination of lung HRCT findings, we investigated the presence of parenchymal micronodules, parenchymal bands, subpleural bands, interlobular and intralobular septal thickening, irregularity of interfaces, ground-glass opacity, consolidation, mosaic pattern, bronchial wall thickening, bronchial dilatation, tracheal dilatation, pleural thickening, emphysema, thoracic cage asymmetry, honeycomb appearance, structural distortion, apical fibrosis and other additional findings.
RESULTS: In detailed HRCT evaluations, lung parenchymal changes were found in 46 (59%) of all patients. We found parenchymal bands in 21 (27%) cases, interlobular septal thickening in 9 (12%), emphysema in 9 (12%), apical fibrosis in 8 (10%), ground-glass opacities in 7 (9%), parenchymal micronodules in 5 (6%), irregularity in interfaces in 3 (4%), bronchial dilatation in 3 (4%), mosaic pattern in 2 (3%), pleural thickening in 2 (3%), consolidation in 1 (1%), bronchial wall thickening in 1 (1%) and a subpleural band in 1 (1%) case. Furthermore, we detected subsegmental atelectasis in 2 patients and a cavitary lesion in 1 patient.
CONCLUSION: Our study had the highest number of AS cases of all previous studies in evaluating lung parenchymal changes. The rate of lung parenchymal changes was slightly lower than that reported in recent literature.
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