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Sebastiani M, Vacchi C, Cassone G, Atzeni F, Biggioggero M, Carriero A, Erre GL, Fedele AL, Furini F, Tomietto P, Venerito V, Atienza-Mateo B, Della Casa G, Cerri S, Sandri G, Palermo A, Galli E, Pancaldi F, González-Gay MA, Salvarani C, Manfredi A. THU0150 INTERSTITIAL LUNG DISEASE RELATED TO RHEUMATOID ARTHRITIS. WHAT DO WE DON’T KNOW? THE LIRA STUDY (LUNG INVOLVEMENT IN RHEUMATOID ARTHRITIS). Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Background:Interstitial lung disease (ILD) is one of the more frequent and potentially severe extra-articular manifestation of rheumatoid arthritis (RA). ILD significantly decreases the survival and quality of life of patients and influences the treatment approach to the patient.Despite its clinical relevance, the prevalence, incidence and survival of RA-ILD is unknown and supposed on the base of retrospective data or registry-based studies.Objectives:For the first time, the Lung Involvement in Rheumatoid Arthritis (LIRA) study aims to investigate epidemiology, features and prognosis of RA-ILD patients in a prospective international multicentre study.Methods:All RA patients referring to the involved centres will be evaluated every six months with a digital stethoscope and a software able to identify velcro crackles with a diagnostic accuracy of 83.9% (VECTOR). In fact, velcro crackles are virtually identified in all stages of fibrosing alveolitis like RA-ILD, and their search is as a simple and reliable method to screening patients to be undergone to high resolution computed tomography (HRCT).For each patient, clinical and serological data are recorded at baseline and every six months; when velcro crackles or other conditions suspicious for ILD, such as cough or dyspnoea, are detected, a HRCT is requested to confirm ILD. Patients with ILD periodically perform pulmonary function tests to monitor lung function evolution.Results:At now, 205 RA patients have been enrolled (female/male 161/44, mean age 64.8±12.9 years, mean disease duration 14.2±8.9 years), anti-citrullinated peptides antibodies (ACPA) and rheumatoid factor (RF) were positive in 77.1% and 78.1%, respectively. The prevalence of ILD was 21% (43 patients). In other 13 patients the HRCT is ongoing; therefore, we could suppose up to a prevalence of 27.3%. Patients with ILD were symptomatic in 53.5% of cases (23 patients), they are more frequently males and were older than patients without ILD (mean age 73.2±7.4 and 62.7±13.2; p<0.0001, female/male ratio 139/23 vs 22/21; p<0.0001) without significant differences regarding disease duration, positivity for ACPA or RF.Conclusion:The prevalence and the incidence of RA-ILD is still not well defined. Preliminary data of our study confirm a prevalence of ILD higher than 20%, patients are asymptomatic in almost the half of cases and more frequently males and elderly. Our study can help to define the clinical history of these patients, the possible association with clinical and serological features and the supposed role of some drugs.References:[1]Manfredi A, et al. Diagnostic accuracy of a velcro sound detector (VECTOR) for interstitial lung disease in rheumatoid arthritis patients: the InSPIRAtE validation study (INterStitial pneumonia in rheumatoid ArThritis with an electronic device). BMC Pulm Med. 2019;19:111.[2]Bendstrup E, et al. Interstitial Lung Disease in Rheumatoid Arthritis Remains a Challenge for Clinicians. J Clin Med. 2019:8Disclosure of Interests:Marco Sebastiani: None declared, Caterina Vacchi: None declared, Giulia Cassone: None declared, Fabiola Atzeni: None declared, Martina Biggioggero: None declared, Antonio Carriero: None declared, Gian Luca Erre: None declared, Anna Laura Fedele: None declared, Federica Furini: None declared, Paola Tomietto: None declared, Vincenzo Venerito: None declared, Belén Atienza-Mateo: None declared, Giovanni Della Casa: None declared, Stefania Cerri: None declared, Gilda Sandri: None declared, Adalgisa Palermo: None declared, Elena Galli: None declared, Fabrizio Pancaldi: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Carlo Salvarani: None declared, Andreina Manfredi: None declared
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Pancaldi F, Páez-Osuna F, Soto-Jiménez MF, González-Armas R, O'Hara T, Marmolejo-Rodríguez AJ, Vázquez A, Galván-Magaña F. Trace Elements in Tissues of Whale Sharks (Rhincodon typus) Stranded in the Gulf of California, Mexico. Bull Environ Contam Toxicol 2019; 103:515-520. [PMID: 31143976 DOI: 10.1007/s00128-019-02640-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 05/25/2019] [Indexed: 06/09/2023]
Abstract
Concentration of essential (Se, Zn and Cu) and non-essential (As, Cd, Hg and Pb) trace elements were measured in selected tissues of two dead whale sharks (Rhincodon typus) stranded in the Gulf of California (GC) in 2017 and 2018. Concentrations of Cd and Pb in the skeletal muscle of the whale shark from La Paz Bay, GC were higher compared to a previous study on whale shark from China. The shark from La Paz Bay also presented higher concentration of Pb in the epidermis, compared to the same tissue of the other whale shark stranded in Punta Bufeo, GC. The Hg in all analysed tissues was lower than those documented in carnivorous sharks. Molar ratio Se:Hg shows an excess of Se over Hg in all the tissues sampled in both sharks.
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Affiliation(s)
- F Pancaldi
- Instituto Politécnico Nacional, Centro Interdisciplinario de Ciencias Marinas, Av. IPN s/n, La Paz, BCS, 23096, Mexico
| | - F Páez-Osuna
- Unidad Académica Mazatlán, Instituto de Ciencias del Mar Y Limnología, Universidad Nacional Autónoma de México (UNAM), Mazatlán, Sinaloa, Mexico
| | - M F Soto-Jiménez
- Unidad Académica Mazatlán, Instituto de Ciencias del Mar Y Limnología, Universidad Nacional Autónoma de México (UNAM), Mazatlán, Sinaloa, Mexico
| | - R González-Armas
- Instituto Politécnico Nacional, Centro Interdisciplinario de Ciencias Marinas, Av. IPN s/n, La Paz, BCS, 23096, Mexico
| | - T O'Hara
- Department of Veterinary Medicine, University of Alaska, Fairbanks, Fairbanks, AK, 99775-7000, USA
| | - A J Marmolejo-Rodríguez
- Instituto Politécnico Nacional, Centro Interdisciplinario de Ciencias Marinas, Av. IPN s/n, La Paz, BCS, 23096, Mexico
| | - A Vázquez
- Asociación de Pesca Deportiva Y Ecoturismo de Bahía de Los Ángeles, Domicilio Conocido, Bahía de Los Ángeles, Baja California, 22980, Mexico
| | - F Galván-Magaña
- Instituto Politécnico Nacional, Centro Interdisciplinario de Ciencias Marinas, Av. IPN s/n, La Paz, BCS, 23096, Mexico.
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Manfredi A, Cassone G, Cerri S, Venerito V, Fedele AL, Trevisani M, Furini F, Addimanda O, Pancaldi F, Della Casa G, D'Amico R, Vicini R, Sandri G, Torricelli P, Celentano I, Bortoluzzi A, Malavolta N, Meliconi R, Iannone F, Gremese E, Luppi F, Salvarani C, Sebastiani M. Diagnostic accuracy of a velcro sound detector (VECTOR) for interstitial lung disease in rheumatoid arthritis patients: the InSPIRAtE validation study (INterStitial pneumonia in rheumatoid ArThritis with an electronic device). BMC Pulm Med 2019; 19:111. [PMID: 31221137 PMCID: PMC6587236 DOI: 10.1186/s12890-019-0875-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 06/11/2019] [Indexed: 01/12/2023] Open
Abstract
Background Interstitial lung disease (ILD) is a severe systemic manifestation of rheumatoid arthritis (RA). High-resolution computed tomography (HRCT) represents the gold standard for the diagnosis of ILD, but its routine use for screening programs is not advisable because of both high cost and X-ray exposure. Velcro crackles at lung auscultation occur very early in the course of interstitial pneumonia, and their detection is an indication for HRCT. Recently, we developed an algorithm (VECTOR) to detect the presence of Velcro crackles in pulmonary sounds and showed good results in a small sample of RA patients. The aim of the present investigation was to validate the diagnostic accuracy of VECTOR in a larger population of RA patients, compared with that of the reference standard of HRCT, from a multicentre study. Methods To avoid X-ray exposure, we enrolled 137 consecutive RA patients who had recently undergone HRCT. Lung sounds of all patients were recorded in 4 pulmonary fields bilaterally with a commercial electronic stethoscope (ES); subsequently, all HRCT images were blindly evaluated by a radiologist, and audio data were analysed by means of VECTOR. Results Fifty-nine of 137 patients showed ILD (43.1%). VECTOR correctly classified 115/137 patients, showing a diagnostic accuracy of 83.9% and a sensitivity and specificity of 93.2 and 76.9%, respectively. Conclusions VECTOR may represent the first validated tool for the screening of RA patients who are suspected for ILD and who should be directed to HRCT for the diagnosis. Moreover, early identification of RA-ILD could contribute to the design of prospective studies aimed at elucidating unclear aspects of the disease.
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Affiliation(s)
- A Manfredi
- Rheumatology Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo, 71 41121, Modena, Italy.
| | - G Cassone
- Rheumatology Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo, 71 41121, Modena, Italy
| | - S Cerri
- Respiratory Disease Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - V Venerito
- Rheumatology Unit, Dipartimento Interdisciplinare di Medicina, University of Bari, 70124, Bari, Italy
| | - A L Fedele
- Rheumatology Unit, Catholic University of the Sacred Heart, 00168, Rome, Italy
| | - M Trevisani
- Rheumatology Unit, Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant'Orsola-Malpighi, 40121, Bologna, Italy
| | - F Furini
- Rheumatology Unit, Clinical and experimental Medicine, Sant'Anna Hospital, 44121, Ferrara, Italy
| | - O Addimanda
- Rheumatology Unit, Department of Biomedical and Neuromotor Sciences, Rizzoli Orthopaedic Institute and University of Bologna, 40136, Bologna, Italy
| | - F Pancaldi
- Department of Sciences and Methods for Engineering, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - G Della Casa
- Radiology Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - R D'Amico
- Unit of Statistics in Medicine, Department of Oncology and Hematology, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - R Vicini
- Unit of Statistics in Medicine, Department of Oncology and Hematology, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - G Sandri
- Rheumatology Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo, 71 41121, Modena, Italy
| | - P Torricelli
- Radiology Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - I Celentano
- Radiology Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - A Bortoluzzi
- Rheumatology Unit, Clinical and experimental Medicine, Sant'Anna Hospital, 44121, Ferrara, Italy
| | - N Malavolta
- Rheumatology Unit, Azienda Ospedaliero-Universitaria di Bologna Policlinico Sant'Orsola-Malpighi, 40121, Bologna, Italy
| | - R Meliconi
- Rheumatology Unit, Department of Biomedical and Neuromotor Sciences, Rizzoli Orthopaedic Institute and University of Bologna, 40136, Bologna, Italy
| | - F Iannone
- Rheumatology Unit, Dipartimento Interdisciplinare di Medicina, University of Bari, 70124, Bari, Italy
| | - E Gremese
- Rheumatology Unit, Catholic University of the Sacred Heart, 00168, Rome, Italy
| | - F Luppi
- Respiratory Disease Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - C Salvarani
- Rheumatology Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo, 71 41121, Modena, Italy.,Rheumatology Unit, Santa Maria Hospital, IRCCS, 42121, Reggio Emilia, Italy
| | - M Sebastiani
- Rheumatology Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo, 71 41121, Modena, Italy
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