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Han S, Ji Z, Liu Y. Screening value of lung ultrasound and pleural shear wave elastography in connective tissue disease-related interstitial lung disease: a preliminary study. Clin Rheumatol 2024; 43:2117-2123. [PMID: 38700662 DOI: 10.1007/s10067-024-06983-8] [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: 01/08/2024] [Revised: 04/19/2024] [Accepted: 04/25/2024] [Indexed: 05/24/2024]
Abstract
OBJECTIVE To explore the diagnostic value of lung ultrasound (LUS) and pleural shear wave elastography (SWE) for connective tissue disease-interstitial lung disease (CTD-ILD). METHODS We selected 104 patients diagnosed with connective tissue disease (CTD) at our hospital. All patients underwent LUS, SWE, and high-resolution computed tomography (HRCT). With HRCT as the imaging gold standard for diagnosis, patients were categorized into CTD-ILD and CTD-non-ILD groups. We employed paired chi-square tests to compare the diagnostic differences between HRCT and LUS for ILD. Receiver operating characteristic (ROC) curves were used to assess the diagnostic value of pleural SWE for ILD. Correlation analysis was performed between pleural elasticity values and lung ultrasound scores. RESULTS The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of LUS for diagnosing CTD-ILD were 93.3%, 86.2%, 6.761, and 0.078, respectively. There was no statistically significant difference in the results between HRCT and LUS (P = 1.000), with a kappa value of 0.720 (P < 0.001). There was a statistically significant difference in the pleural elasticity in the bilateral lower back region between the case and control groups (P < 0.001). The area under the receiver operating characteristic (ROC) curve (AUC) for pleural SWE in diagnosing CTD-ILD was 0.685. In CTD-ILD patients, there was no significant correlation between pleural elasticity values and LUS scores (P > 0.05). CONCLUSION The LUS can serve as an important imaging method for screening for CTD-ILD and assessing the severity of the disease. However, pleural SWE has been shown to demonstrate lower diagnostic efficacy for CTD-ILD, and its ability to assess disease severity is limited.
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Affiliation(s)
- Shiyao Han
- Department of Ultrasound, The First Hospital of China Medical University, 155 Nanjingbei Street, Heping District, Shenyang, Shenyang, 110004, Liaoning, China
| | - Ziyao Ji
- Department of Ultrasound, The First Hospital of China Medical University, 155 Nanjingbei Street, Heping District, Shenyang, Shenyang, 110004, Liaoning, China
| | - Yanjun Liu
- Department of Ultrasound, The First Hospital of China Medical University, 155 Nanjingbei Street, Heping District, Shenyang, Shenyang, 110004, Liaoning, China.
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2
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Serrano-Warleta M, Palomeque-Vargas A, Manzo R, Blanco-Cáceres B, Vazquez-Díaz M, Guillen-Astete C. Usefulness of ultrasound in clinical decision-making in rheumatology clinical practice: A single-center longitudinal study. REUMATOLOGIA CLINICA 2024; 20:147-149. [PMID: 38431489 DOI: 10.1016/j.reumae.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/15/2023] [Indexed: 03/05/2024]
Abstract
OBJECTIVE The purpose of the present study is to identify the extent to which it affects clinical decisions in a single-centre observational retrospective study. METHOD The results of 801 requests and 1174 consecutive individual ultrasound examinations performed over 10 months were analysed. RESULTS The most frequent indication was diagnostic assistance (39%) followed by assessment of inflammatory activity (34%). By topography, the hand was the most frequently studied region (51%), followed by the foot (18.1%). Of all requests, 67% had an impact on decision-making. The impact on clinical decision-making was associated with a shorter waiting time for the evaluation of the results, being the greatest in those ultrasound scans performed on demand on the same day of the request. In 73% of bilateral ultrasound studies, findings in one of the joints exemplified the overall result reported. CONCLUSIONS Rheumatological musculoskeletal ultrasound has proven to be a useful decision-making technique, the greater the impact of which is seen the shorter the waiting time before it is performed.
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Affiliation(s)
| | | | - Rosa Manzo
- Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Boris Blanco-Cáceres
- Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Unidad de Imagen y Procedimientos Ecoguiados, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Mónica Vazquez-Díaz
- Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Unidad de Imagen y Procedimientos Ecoguiados, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Carlos Guillen-Astete
- Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Unidad de Imagen y Procedimientos Ecoguiados, Hospital Universitario Ramón y Cajal, Madrid, Spain.
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3
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Santos-Moreno P, Linares-Contreras MF, Rodríguez-Vargas GS, Rodríguez-Linares P, Mata-Hurtado A, Ibatá L, Martínez S, Rojas-Villarraga A, Diaz M, Vicente-Rabaneda EF, Quintero M, Möller I. Usefulness of Lung Ultrasound as a Method for Early Diagnosis of Interstitial Lung Disease in Patients with Rheumatoid Arthritis. Open Access Rheumatol 2024; 16:9-20. [PMID: 38249427 PMCID: PMC10800103 DOI: 10.2147/oarrr.s441720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose To determine the value of lung ultrasound (LUS) compared to high-resolution computed tomography (HRCT) in the early diagnosis of interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA). Patients and Methods An observational prospective study was performed. Were included patients with respiratory symptoms or/and, patients with crackles in auscultation during medical consultation. All patients underwent to chest X-rays, LUS, HRCT,and respiratory function tests. Results A total of 192 patients with RA were included. Mean disease duration was 16.8 ± 11.1 years. 72% were positive for rheumatoid factor or anti-citrullinated antibodies. Of the total number of subjects, 54.7% had respiratory symptoms. The other patients did not have respiratory symptoms, but they did have had crackles on pulmonary auscultation. B lines > 11.5 on the ROC curve predicted ILD (AUC 0.63; CI 95%: 0.55-0.71; p < 0.003). A DLCO value of <7.13 significantly predicted the presence of ILD (AUC 0.61; 95% CI: 0.52-0.70; p < 0.028). Conclusion The findings of this study suggest that LUS is a valuable tool for the early diagnosis of ILD in patients with RA, and together with DLCO, can adequately predict the presence of ILD in this population. LUS also helps to determine which patients with respiratory symptoms and signs suggestive for ILD are undergo to HRCT.
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Affiliation(s)
| | | | | | | | | | - Linda Ibatá
- Epidemiology department, Biomab IPS, Bogotá, Colombia
| | | | - Adriana Rojas-Villarraga
- Rheumatology Department, Biomab IPS, Bogotá, Colombia
- Research Institute, Fundación Universitaria de Ciencias de La Salud – FUCS, Bogotá, Colombia
| | - Mario Diaz
- Rheumatology Department, Biomab IPS, Bogotá, Colombia
| | | | | | - Ingrid Möller
- POAL Rheumatology Institute, Rheumatology, Barcelona, Spain
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4
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Atienza-Mateo B, Fernández-Díaz C, Vicente-Rabaneda EF, Melero-González RB, Ortiz-Sanjuán F, Casafont-Solé I, Rodríguez-García SC, Ferraz-Amaro I, Castañeda S, Blanco R. Abatacept in usual and in non-specific interstitial pneumonia associated with rheumatoid arthritis. Eur J Intern Med 2024; 119:118-124. [PMID: 37673775 DOI: 10.1016/j.ejim.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/21/2023] [Accepted: 08/26/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To compare the effectiveness of abatacept (ABA) in Rheumatoid Arthritis-associated Interstitial Lung Disease (RA-ILD) according to the radiological patterns of usual (UIP) or non-specific interstitial pneumonia (NSIP). METHODS From an observational longitudinal multicentre study of 263 RA-ILD patients treated with ABA, those with UIP or NSIP were selected. Lung function, chest high resolution computerised tomography (HRCT) and dyspnoea were recorded and compared in both groups from baseline to the end of follow-up (progression definitions: improvement or worsening >10% of FVC or DLCO, changes in HRCT extension and 1-point change in the mMRC scale, respectively). Differences between final and baseline visits were calculated as the average difference (95% CI) through mixed effects models regression. RESULTS We studied 190 patients with UIP (n=106) and NSIP (n=84). General features were similar in both groups except for older age, positive rheumatoid factor, and previous sulfasalazine therapy, which were more frequent in patients with UIP. ILD duration up to ABA initiation was relatively short: median 16 [4-50] and 11 [2-36] months (p=0.36) in UIP and NSIP, respectively. Mean baseline FVC and DLCO were 82% and 63% in UIP and 89% and 65% in NSIP, respectively. Both parameters remained stable during 24 months with ABA. HRCT lesions and dyspnoea improved/stabilized in 73.1% and 90.5% and 72.9% and 94.6% of UIP and NSIP patterns, respectively. CONCLUSION ABA seems equally effective in stabilizing dyspnoea, lung function and radiological impairment in both UIP and NSIP patterns of RA-ILD. Early administration of ABA may prevent RA-ILD progression, regardless of the radiological pattern.
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Affiliation(s)
- Belén Atienza-Mateo
- Rheumatology, Hospital Universitario Marqués de Valdecilla, Immunopathology group, IDIVAL, Santander, Avda.Valdecilla s/n., ES, 39008, Spain
| | | | | | | | | | | | | | - Iván Ferraz-Amaro
- Rheumatology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Santos Castañeda
- Rheumatology, Hospital de La Princesa, IIS-Princesa, Madrid, Spain; Cátedra UAM-Roche, EPID-Future, Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ricardo Blanco
- Rheumatology, Hospital Universitario Marqués de Valdecilla, Immunopathology group, IDIVAL, Santander, Avda.Valdecilla s/n., ES, 39008, Spain.
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5
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Fairchild RM, Deluna MD, Golovko V, Mar DA, Baker MC, Nishio J, Horomanski AL. Evolution and impact of a dedicated ultrasound clinic on clinical rheumatology practice at an academic medical center. Semin Arthritis Rheum 2023; 63:152276. [PMID: 37857047 DOI: 10.1016/j.semarthrit.2023.152276] [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: 06/29/2023] [Revised: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Rheumatologic ultrasonography (RhUS) has grown in scope and application over the past 20 years. While many studies have shown the benefits of RhUS, few have investigated the efficacy of a dedicated clinic. This study explores the impact of a dedicated ultrasound clinic on patients and rheumatologists at an academic medical center (AMC). METHODS We analyzed claims data for patient visits, X-rays (XR), magnetic resonance imaging (MRI), and RhUS from an AMC with an established RhUS clinic, alongside two affiliated community medical practices (CMPs) without RhUS. We also analyzed RhUS clinic records on referral indication, procedures, results, and follow-up treatment changes. Pre- and post-RhUS visit patient surveys and referring physician (RP) surveys assessed experience and impact of the RhUS clinic. RESULTS From 2018 to 2021, referrals to the RhUS clinic substantially increased. In parallel, XR and MRI orders changed by -76 % and -43 % respectively, compared with 163 % and -24 % at CMPs. Discordance between RP pre-RhUS assessments and RhUS results were common. Patient surveys showed RhUS led to increased disease understanding and impacted thoughts and decisions about their therapy. RPs found utility in RhUS across a range of indications and were confident with RhUS results. CONCLUSIONS These findings suggest a dedicated RhUS clinic can be a valuable resource in clinical rheumatology practice. Implementation of a RhUS clinic at this AMC spurred rapid adoption of RhUS into clinical decision-making with notable benefits for patients and physicians alike. This may serve as a model for implementation of similar clinics at other institutions.
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Affiliation(s)
- Robert M Fairchild
- Division of Immunology & Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA.
| | - Mariani D Deluna
- Division of Immunology & Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Valentyn Golovko
- Stanford Health Care, Department of Quality, Patient Safety & Effectiveness, Stanford Hospital and Clinics, Palo Alto, CA, USA
| | - Diane A Mar
- Division of Immunology & Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Matthew C Baker
- Division of Immunology & Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Jane Nishio
- Division of Immunology & Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Audra L Horomanski
- Division of Immunology & Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA
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6
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Scarlata S, Okoye C, Zotti S, Lauretani F, Nouvenne A, Cerundolo N, Bruni AA, Torrini M, Finazzi A, Mazzarone T, Lunian M, Zucchini I, Maccioni L, Guarino D, Fabbri Della Faggiola S, Capacci M, Bianco MG, Guarona G, Bellelli G, Monzani F, Virdis A, Antonelli Incalzi R, Ungar A, Ticinesi A. Advancing healthcare through thoracic ultrasound research in older patients. Aging Clin Exp Res 2023; 35:2887-2901. [PMID: 37950845 PMCID: PMC10721707 DOI: 10.1007/s40520-023-02590-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/08/2023] [Indexed: 11/13/2023]
Abstract
This paper reports the proceedings of a meeting convened by the Research Group on Thoracic Ultrasound in Older People of the Italian Society of Gerontology and Geriatrics, to discuss the current state-of-the-art of clinical research in the field of geriatric thoracic ultrasound and identify unmet research needs and potential areas of development. In the last decade, point-of-care thoracic ultrasound has entered clinical practice for diagnosis and management of several respiratory illnesses, such as bacterial and viral pneumonia, pleural effusion, acute heart failure, and pneumothorax, especially in the emergency-urgency setting. Very few studies, however, have been specifically focused on older patients with frailty and multi-morbidity, who frequently exhibit complex clinical pictures needing multidimensional evaluation. At the present state of knowledge, there is still uncertainty on the best requirements of ultrasound equipment, methodology of examination, and reporting needed to optimize the advantages of thoracic ultrasound implementation in the care of geriatric patients. Other issues regard differential diagnosis between bacterial and aspiration pneumonia, objective grading of interstitial syndrome severity, quantification and monitoring of pleural effusions and solid pleural lesions, significance of ultrasonographic assessment of post-COVID-19 sequelae, and prognostic value of assessment of diaphragmatic thickness and motility. Finally, application of remote ultrasound diagnostics in the community and nursing home setting is still poorly investigated by the current literature. Overall, the presence of several open questions on geriatric applications of thoracic ultrasound represents a strong call to implement clinical research in this field.
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Affiliation(s)
- Simone Scarlata
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Department of Medicine and Surgery, Research Unit of Geriatrics, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Chukwuma Okoye
- School of Medicine and Surgery, University of Milano-Bicocca, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy.
- Department of Neurobiology, Care Sciences and Society, Department of Geriatrics Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Sonia Zotti
- Department of Medicine and Surgery, Research Unit of Geriatrics, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Fulvio Lauretani
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Antonio Nouvenne
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Nicoletta Cerundolo
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Adriana Antonella Bruni
- Acute Geriatric Unit, Fondazione IRCCS San Gerardo de Tintori, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy
| | - Monica Torrini
- Geriatrics and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Alberto Finazzi
- School of Medicine and Surgery, University of Milano-Bicocca, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy
| | - Tessa Mazzarone
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Marco Lunian
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Irene Zucchini
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Lorenzo Maccioni
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Daniela Guarino
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | | | - Marco Capacci
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Maria Giovanna Bianco
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Guglielmo Guarona
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy
- Acute Geriatric Unit, Fondazione IRCCS San Gerardo de Tintori, Via Giovanni Battista Pergolesi 33, 20900, Monza, Italy
| | - Fabio Monzani
- Casa di Cura Venerabile Confraternita di Misericordia Navacchio, 56023, Pisa, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Raffaele Antonelli Incalzi
- Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Department of Medicine and Surgery, Research Unit of Geriatrics, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Andrea Ungar
- Geriatrics and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
- Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126, Parma, Italy
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7
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Vermant M, Kalkanis A, Goos T, Cypers H, De Crem N, Neerinckx B, Taelman V, Verschueren P, Wuyts WA. Ultrasonographic Presentation and Anatomic Distribution of Lung Involvement in Patients with Rheumatoid Arthritis. Diagnostics (Basel) 2023; 13:2986. [PMID: 37761353 PMCID: PMC10529908 DOI: 10.3390/diagnostics13182986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/05/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic auto-immune disease, typically affecting the joints, which can also present with lung involvement (pleuritis, interstitial lung disease, pulmonary nodules, etc.). Lung ultrasound (LUS) is an upcoming tool in the detection of these pulmonary manifestations. METHODS We performed a 72-window LUS in 75 patients presenting to the outpatient rheumatology clinic and describe the abnormalities (presence of B-lines (vertical comet-tail artefacts), pleural abnormalities, pleural effusions, and subpleural nodules) on lung ultrasound. We created a topological mapping of the number of B-lines per intercostal zone. RESULTS We observed pleural effusions, pleural abnormalities, and pleural nodules in, respectively, 1.3%, 45.3%, and 14% of patients. There were 35 (46.7%) patients who had less than 5 B-lines, 15 (20%) patients who had between 5 and 10 B-lines, 11 (14.6%) between 10 and 20, 10 (13.3%) between 20 and 50, 1 (1.3%) between 50 and 100, and 3 (4%) of patients who had more than 100 B-lines. CONCLUSIONS LUS in patients with RA shows an array of abnormalities ranging from interstitial syndromes to pleural abnormalities, subpleural nodules, and pleural effusions. Hotspots for the presence of B-lines are situated bilaterally in the posterior subscapular regions, as well as the anterior right mid-clavicular region.
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Affiliation(s)
- Marie Vermant
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium (W.A.W.)
- Department of Pulmonology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Alexandros Kalkanis
- Department of Pulmonology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Tinne Goos
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium (W.A.W.)
- Department of Pulmonology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Heleen Cypers
- Department of Rheumatology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Nico De Crem
- Department of Pulmonology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Barbara Neerinckx
- Department of Rheumatology, University Hospitals Leuven, 3000 Leuven, Belgium
- Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Veerle Taelman
- Department of Rheumatology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Patrick Verschueren
- Department of Rheumatology, University Hospitals Leuven, 3000 Leuven, Belgium
- Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Wim A. Wuyts
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium (W.A.W.)
- Department of Pulmonology, University Hospitals Leuven, 3000 Leuven, Belgium
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8
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Hernández Muñiz S, Olivera Serrano M, Jiménez Heffernan J, Valenzuela C, Caballero Sánchez-Robles P. Enfermedad intersticial asociada a conectivopatías y vasculitis. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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9
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Vicente-Rabaneda EF, Bong D, Möller I, Castañeda S. Response to "Subclinical interstitial lung disease in patients with systemic sclerosis. A pilot study on the role of ultrasound". REUMATOLOGIA CLINICA 2022; 18:624. [PMID: 34764057 DOI: 10.1016/j.reumae.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/29/2021] [Indexed: 12/24/2022]
Affiliation(s)
| | - David Bong
- Facultad de Medicina, Universidad de Barcelona-Bellvitge Campus, Instituto Poal de Reumatología, Barcelona, Spain
| | - Ingrid Möller
- EULAR Working Group Anatomy for the Image, Instituto Poal de Reumatología, Universidad de Barcelona, Universidad Internacional de Cataluña, Barcelona, Spain
| | - Santos Castañeda
- Servicio de Reumatología, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain; Cátedra ROCHE-UAM, EPID-Futuro, Universidad Autónoma de Madrid, Madrid, Spain
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10
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Hernández Muñiz S, Olivera Serrano MJ, Jiménez Heffernan JA, Valenzuela C, Caballero Sánchez-Robles P. Interstitial disease associated with connective tissue disease and vasculitis. RADIOLOGIA 2022; 64 Suppl 3:250-264. [PMID: 36737164 DOI: 10.1016/j.rxeng.2022.07.004] [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: 05/30/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023]
Abstract
Systemic autoimmune diseases comprise a complex, heterogeneous group of entities. Noteworthy among the pulmonary complications of these entities is interstitial involvement, which manifests with the same radiopathologic patterns as in idiopathic interstitial pneumonia. High-resolution computed tomography is the gold-standard imaging technique; it enables us to identify and classify the disease and to determine its extent, providing useful information about the prognosis. In this group of processes, the most common pattern of presentation is nonspecific interstitial pneumonia. It is essential for radiologists to work together in collaboration with other specialists to reach the correct diagnosis and enable appropriate, integrated treatment.
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Affiliation(s)
- S Hernández Muñiz
- Servicio de Radiodiagnóstico, Hospital Universitario de La Princesa, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain; Cátedra UAM-Roche EPID-futuro (Universidad Autónoma de Madrid), Madrid, Spain.
| | - M J Olivera Serrano
- Servicio de Radiodiagnóstico, Hospital Universitario de La Princesa, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain
| | - J A Jiménez Heffernan
- Universidad Autónoma de Madrid, Madrid, Spain; Servicio de Anatomía Patológica, Hospital Universitario de La Princesa, Madrid, Spain
| | - C Valenzuela
- Universidad Autónoma de Madrid, Madrid, Spain; Cátedra UAM-Roche EPID-futuro (Universidad Autónoma de Madrid), Madrid, Spain; Servicio de Neumología, Hospital Universitario de La Princesa, Madrid, Spain
| | - P Caballero Sánchez-Robles
- Servicio de Radiodiagnóstico, Hospital Universitario de La Princesa, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain
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11
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Lung Ultrasound Signs to Diagnose and Discriminate Interstitial Syndromes in ICU Patients: A Diagnostic Accuracy Study in Two Cohorts. Crit Care Med 2022; 50:1678-1680. [PMID: 36227040 DOI: 10.1097/ccm.0000000000005671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Huang S, Guo R, Yuan X, Tang X, Liu T, Xie Q, Qiu L. Evaluation of connective tissue disease-related interstitial lung disease using ultrasound elastography: a preliminary study. Quant Imaging Med Surg 2022; 12:3778-3791. [PMID: 35782243 PMCID: PMC9246744 DOI: 10.21037/qims-21-1205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/14/2022] [Indexed: 11/25/2023]
Abstract
BACKGROUND Interstitial lung disease (ILD) is a common pulmonary complication of connective tissue disease (CTD), which can lead to shortened survival. This article explores the ability of shear wave elastography (SWE) to assess lung surface elastic properties and to distinguish healthy lungs from diseased lungs with connective tissue disease-related interstitial lung disease (CTD-ILD). We aimed to determine whether SWE can be used to assess the severity of CTD-ILD. METHODS A total of 65 CTD-ILD patients and 60 healthy volunteers were included for the case group and the control group, respectively. All participants underwent lung ultrasound (count of B-line and measurement of pleural line thickness) and SWE [measurement of Young's modulus (Emean) and shear wave velocity (SMV) (Cmean)] examinations at 50 lung sites. All participants also underwent an examination with high-resolution computed tomography (HRCT) and a pulmonary function test (PFT). For SWE assessment, the Q-box was set to its minimum size (1 mm) and manually placed on the pleural line, rather than inside the lung, to measure the stiffness of the lung surface. The intra- and inter-reliability of SWE measurements of healthy controls (HC), the receiver operating characteristic (ROC) curve for SWE for CTD-ILD, and correlations between different assessment methods were analyzed. RESULTS Excellent intra- and inter-reliability of SWE measurements on the mid-anterior lung site of HCs (correlation coefficient >0.97; P<0.01) were found. The results of the lung ultrasound of case group participants were significantly higher than those of HCs at each site (P<0.001). The SWE results revealed a significant increase in both Emean and Cmean in CTD-ILD patients (P<0.001) compared with HCs at certain sites (P<0.001). The areas under the curve (AUC) of Emean and Cmean for CTD-ILD were 0.646 and 0.647 (P<0.05), respectively, and the cutoff values for Emean and Cmean to distinguish CTD-ILD from healthy lungs were 15.81 kPa and 2.31 m/s, respectively. There was no significant correlation between the SWE measured values and the number of B-lines, or the HRCT and PFT results, respectively (P>0.05). CONCLUSIONS As a noninvasive ultrasound elastography (UE) technique, SWE may provide a novel method to differentiate CTD-ILD-affected lungs and healthy lungs. It is a reliable way to measure the stiffness of a healthy lung surface in the supine position. However, the ability of SWE to evaluate the severity of CTD-ILD may be limited.
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Affiliation(s)
- Songya Huang
- Department of Medical Ultrasound and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Ruiqian Guo
- Department of Medical Ultrasound and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Xinhui Yuan
- Department of Medical Ultrasound, The People’s Hospital of Leshan, Leshan, China
| | - Xinyi Tang
- Department of Medical Ultrasound and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Tao Liu
- Department of Rheumatology and Immunology, West China Hospital of Sichuan University, Chengdu, China
| | - Qibing Xie
- Department of Rheumatology and Immunology, West China Hospital of Sichuan University, Chengdu, China
| | - Li Qiu
- Department of Medical Ultrasound and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China
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de Alegria SG, Litrento PF, de Oliveira Farias I, Mafort TT, Lopes AJ. Can home rehabilitation impact impulse oscillometry and lung ultrasound findings in patients with scleroderma-associated interstitial lung disease? A pilot study. BMC Res Notes 2022; 15:176. [PMID: 35570301 PMCID: PMC9107596 DOI: 10.1186/s13104-022-06064-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/05/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Exercise has been demonstrated to be beneficial for improving physical capacity and quality of life in people with scleroderma, although knowledge of its impact on the respiratory system is limited. This study evaluated the impact of therapist-oriented home rehabilitation (TOHR) on impulse oscillometry (IOS) and lung ultrasound (LUS) findings in patients with scleroderma-associated interstitial lung disease (ILD). Results Twelve women with scleroderma underwent spirometry, IOS, and LUS before and after performing TOHR. Regarding spirometry, a normal pattern and restrictive damage were observed in five (41.7%) and seven (58.3%) participants pre-TOHR and post-TOHR, respectively. For IOS, an abnormal result was detected in nine (75%) pre-TOHR participants and six (50%) post-TOHR participants. Heterogeneity of resistance between 4–20 Hz (R4-R20) > 20% of the predicted value was observed in eight (66.7%) pre-TOHR participants and three (25%) post-TOHR participants (P = 0.031). An abnormal LUS result was observed in nine (75%) participants both pre-TOHR and post-TOHR. The main change observed was B-lines > 2, which was noted in nine (75%) participants both pre-TOHR and post-TOHR. Our findings suggest that TOHR for women with scleroderma-associated ILD improves the resistance and reactance measured by IOS, including small airway disease. Trial Registration ClinicalTrials.gov ID: NCT05041868 Registered on: 13th September 2021.
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Koshy V, Patel K, Yadav D, Saxena P, George RA, Gangadharan V, Koshy G. Descriptive study of the role of ultrasound in the evaluation of patients with interstitial lung disease associated with autoimmune connective tissue disorders. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_159_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ruaro B, Baratella E, Confalonieri P, Confalonieri M, Vassallo FG, Wade B, Geri P, Pozzan R, Caforio G, Marrocchio C, Cova MA, Salton F. High-Resolution Computed Tomography and Lung Ultrasound in Patients with Systemic Sclerosis: Which One to Choose? Diagnostics (Basel) 2021; 11:2293. [PMID: 34943531 PMCID: PMC8700001 DOI: 10.3390/diagnostics11122293] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 02/07/2023] Open
Abstract
Imaging plays a pivotal role in systemic sclerosis for both diagnosis management of pulmonary complications, and high-resolution computed tomography (HRCT) is the most sensitive technique for the evaluation of systemic sclerosis-associated interstitial lung disease (SSc-ILD). Indeed, several studies have demonstrated that HRCT helps radiologists and clinicians to make a correct diagnosis on the basis of recognised typical patterns for SSc-ILD. Most SSc patients affected by ILD have a non-specific interstitial pneumonia pattern (NISP) on HRCT scan, whilst a minority of cases fulfil the criteria for usual interstitial pneumonia (UIP). Moreover, several recent studies have demonstrated that lung ultrasound (LUS) is an emergent tool in SSc diagnosis and follow-up, although its role is still to be confirmed. Therefore, this article aims at evaluating the role of LUS in SSc screening, aimed at limiting the use of CT to selected cases.
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Affiliation(s)
- Barbara Ruaro
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Paola Confalonieri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Marco Confalonieri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Fabio Giuseppe Vassallo
- Department of Pulmonology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34149 Trieste, Italy;
| | - Barbara Wade
- AOU City of Health and Science of Turin, Department of Science of Public Health and Pediatrics, University of Torino, 10124 Torino, Italy;
| | - Pietro Geri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Riccardo Pozzan
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Gaetano Caforio
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Cristina Marrocchio
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Maria Assunta Cova
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Francesco Salton
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
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Vicente-Rabaneda EF, Serra López-Matencio JM, Ancochea J, Blanco R, González-Gay MÁ, Castañeda S. Efficacy and safety of biological drugs in interstitial lung disease associated with connective tissue diseases. Expert Opin Drug Saf 2021; 21:311-333. [PMID: 34433372 DOI: 10.1080/14740338.2021.1973428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Interstitial lung disease (ILD) is one of the most important manifestations of connective tissue diseases (CTD) due to its association with high morbidity and mortality. AREAS COVERED Literature review focused on the evidence on efficacy and safety of biological therapy. EXPERT OPINION Rituximab (RTX) is the most studied drug, though tocilizumab (TCZ) has methodologically more robust evidence, whereas abatacept (ABA) has only anecdotal reports. RTX studies suggest a clinically relevant effect on lung function and fibrosis in refractory to conventional treatment patients, with a good safety profile. Its multi-level efficacy in systemic sclerosis and the potentially more favorable response of anti-synthetase syndrome, especially when administered early in acute-onset or exacerbated ILD stand out over current standard of care, pending the availability of randomized controlled clinical trials. The significant and clinically meaningful benefit found in lung function and fibrosis with TCZ in faSScinate and focuSSced trials represents a change with respect to the usual practice, reinforcing the importance of treatment in early subclinical or clinical SSc-ILD patients with risk factors for ILD progression. This evidence has led to the inclusion of both RTX and TCZ in the expert-based therapeutic algorithms or recommendations for CTD-ILD management.
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Affiliation(s)
| | | | - Julio Ancochea
- Pneumology Division, Hospital Universitario de La Princesa, Madrid, Spain.,Cathedra UAM-Roche, EPID-Future, Medicine Department, Universidad Autónoma de Madrid, Spain
| | - Ricardo Blanco
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, Spain
| | - Miguel Á González-Gay
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla, Spain.,Department of Medicine, University of Cantabria, Santander, Spain.,Faculty of Health Sciences, University of Witwatersrand, Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, South Africa
| | - Santos Castañeda
- Rheumatology Division, Hospital Universitario de La Princesa, Madrid, Spain.,Cathedra UAM-Roche, EPID-Future, Medicine Department, Universidad Autónoma de Madrid, Spain
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Vicente-Rabaneda EF, Bong D, Möller I, Castañeda S. Response to "Subclinical Interstitial Lung Disease in Patients with Systemic Sclerosis. A Pilot Study on the Role of Ultrasound". REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00154-6. [PMID: 34215547 DOI: 10.1016/j.reuma.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/29/2021] [Indexed: 06/13/2023]
Affiliation(s)
| | - David Bong
- Facultad de Medicina, Universidad de Barcelona-Bellvitge Campus, Instituto Poal de Reumatología, Barcelona, España
| | - Ingrid Möller
- EULAR Working Group Anatomy for the Image, Instituto Poal de Reumatología, Universidad de Barcelona, Universidad Internacional de Cataluña, Barcelona, España
| | - Santos Castañeda
- Servicio de Reumatología, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, España; Cátedra ROCHE-UAM, EPID-Futuro, Universidad Autónoma de Madrid, Madrid, España
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