¹LMU University Hospital Munich, Department of Pneumology, Munich
²MVZ für Rheumatologie Dr. M. Welcker, Planegg
³Augustinum Hospital Munich, Department of Pneumology, Munich
⁴Clinic of Pulmonary Medicine, Seefeld-Hechendorf
⁵Medical University Graz, Department of Pneumology, Graz
⁶M.B.W.-Welcker GbR, Rheumatologie, Planegg

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Introduction: Rheumatoid Arthritis (RA), in particular Rheumafactor- and ACPA-positive RA, is associated with a significantly higher risk for pulmonary and cardiovascular comorbidities [1], [2].

In order to achieve a better prognosis as well as a better therapeutic outcome early detection of pulmonary comorbidities, in particular of interstitial lung disease (ILD), is crucial. Despite its great relevance, no recommendations for a screening protocol are not yet issued.

Methods: In this study, we enrolled 214 consecutive patients with a confirmed diagnosis of seropositive and ACPA-positive RA, who exhibited no symptoms or prior history of cardiopulmonary disease. To screen for pulmonary, pleural, or vascular manifestations of RA, we utilized noninvasive, radiation-free methods, including pulmonary function tests (PFT), cardiopulmonary exercise testing (CPET), echocardiography, and pleuro-pulmonary transthoracic ultrasound (LUS). The study was divided into two phases.

Results: 203 patients (mean age 59,2 ±12,2 years, 76% female, 16,7% current smokers and 26,6% previous smokers) were examined.

The average duration of disease in the overall cohort is 8.3 (±7.1) years, with 32% of patients (n=64) suffering from an erosive course of RA.

In total, the disease activity of the cohort is in remission, regardless of the method used to measure disease activity (DAS28CRP 2.3, CDAI 5.7, SDAI 6.2, BSG 16.4, CRP 4.5).

In the pulmonary function test, 81 patients (42%) showed abnormalities. With a mean FVC of 97.3%, the comparison of the ILD-group vs. non-ILD-group showed differences in DLCOc% (68.2%±13.5 vs. 82.4%±14.9). Sonographic changes were seen in 107 patients (52.7%), with 29% (n=58) showing typical LUS pattern compatible with ILD such as B-lines, comet tail artifacts and pleural irregularities3.With the parallel occurrence of characteristic alterations in LUS as well as additional changes in PFT, ILD was suspected, affecting 15.1% of the patients (n=30).

Secondary findings included pleural consolidation suspected of malignancy and pleural effusion on LUS, severe aortic stenosis in the context of a bicuspid aortic valve, and severely impaired diffusion capacity due to pulmonary emphysema and obstructive lung disease.

Conclusion: In conclusion, this novel screening protocol including lung sonography for RA patients enables the early detection of pulmonary manifestation of RA and various other cardiopulmonary comorbidities, revealing a significant number of asymptomatic patients.

Figure 1 [Fig. 1]

Table 1 [Tab. 1]

References

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[2] Kadura S, Raghu G. Rheumatoid arthritis-interstitial lung disease: manifestations and current concepts in pathogenesis and management. Eur Respir Rev. 2021 Jun 23;30(160):210011. DOI: 10.1183/16000617.0011-2021
[3] Gargani L. Lung ultrasound: a new tool for the cardiologist. Cardiovasc Ultrasound. 2011 Feb 27;9:6. DOI: 10.1186/1476-7120-9-6