Lung ultrasound in patients with rheumatoid arthritis: definition of significant interstitial lung disease.

OBJECTIVES: The aim of this study was to determine the cut-off number of lung ultrasound (LUS) B-lines that identifies a significant rheumatoid arthritis-interstitial lung disease (RA-ILD). METHODS: RA patients with suspected RA-ILD were consecutively enrolled. Patients underwent LUS (carried out in 14 defined intercostal spaces), chest HRCT, pulmonary function tests, and clinical evaluation. The diagnosis of RA-ILD was based on a semi-quantitative evaluation of chest HRCT using a computer-aided method (CaM). The discriminative validity of the LUS versus HRCT has been studied by using the receiver operating characteristic (ROC) curve analysis. RESULTS: 72 consecutive RA patients (21 male, 51 female) were evaluated, with a mean age of 63.0 (SD 11.5 years). The mean estimate of pulmonary fibrosis using the CaM was 11.20% (SD 7.48) at chest HRCT, while at LUS the mean number of B-lines was 10.65 (SD 15.11). A significant RA-ILD, as measured by the CaM at HRCT, was detected in 25 patients (34.7%). The presence of 9 B-lines was found to be the optimal cut-off at ROC curve analysis. This LUS cut-off defines the presence of significant RA-ILD with a sensitivity of 70.0%, a specificity of 97.62%, and a positive likelihood ratio of 29.4. CONCLUSIONS: The present study provided data to determine the number of B-lines to identify a significant RA-ILD. LUS may represent a useful technique to select RA patients to be assessed by chest HRCT.

A retrospective study of the efficacy of JAK inhibitors or abatacept on rheumatoid arthritis-interstitial lung disease.

OBJECTIVES: To examine the effectiveness of Janus-kinase inhibitors (JAKis) or abatacept (ABA) in patients with rheumatoid arthritis-interstitial lung disease (RA-ILD). METHODS: Patients with RA-ILD receiving JAKis or ABA were retrospectively evaluated at baseline and after 18 months of treatment. A computer-aided method (CaM) was used to assess the extent of high-resolution computed tomography (HRCT) fibrosis percentage. According to HRCT fibrosis changes, patients were classified as "worsened" (progression of 15% or more), "stable" (changes within 15%) or "improved" (reduction of 15% or more). Correlations between RA characteristics and JAKis or ABA responses were studied using a multivariate regression model. RESULTS: Seventy-five patients (69.3% women) were evaluated, 31 received a JAKi while 44 received ABA. In the JAKis group, five patients (16.1%) showed RA-ILD progression, 20 patients (64.5%) were considered stable, and six patients (19.4%) demonstrated RA-ILD improvement. In the ABA group, five patients (11.3%) showed RA-ILD progression, 32 patients (72.7%) were stable, and seven patients (16.0%) demonstrated RA-ILD improvement. In both groups, the percentage of current smokers was different between those classified as "worsened" and those classified as "improved/stable" (p = 0.01). In multivariate regression analysis, current smoking habit (p = 0.0051) and concomitant methotrexate treatment (p = 0.0078) were the two variables related to RA-ILD progression in ABA-treated patients, whereas in JAKis-treated patients, the only RA-ILD progression-related variable was disease duration of RA (p < 0.001). CONCLUSIONS: Treatment with JAKis or ABA was related to stability or improvement of RA-ILD in 83.9% and 88.6% of patients, respectively. RA duration is the only variable associated with worsening RA-ILD in JAKis-treated patients.

Ultrasound-Guided Procedures in Rheumatology Daily Practice: Feasibility, Accuracy, and Safety Issues.

BACKGROUND/OBJECTIVE: The aims of this study were to describe in detail the ultrasound (US)-guided procedures in our daily rheumatology practice, to evaluate the feasibility and accuracy of US-guided procedures, and to test the efficacy of our disinfection protocol in preventing infectious complications. METHODS: This was a cross-sectional and monocentric study. Information regarding patients' age, sex, body mass index, rheumatic disease, US pathological findings, aspirated and/or injected anatomical site, US equipment (ie, probe type and frequency), and needle type was consecutively collected for each US-guided procedure in a third-level rheumatology center. RESULTS: A total of 643 US-guided procedures were performed, with a mean of 5.2 procedures per working-day. In 94.2% of the patients, only one procedure was carried out, whereas in 5.8%, more than one. The mean time was 7 ± 2.5 minutes. Ultrasound-guided procedures were highly accurate (accuracy rate higher than 95%) and safe (adverse events were reported in 0.8%). Our disinfection protocol was effective in preventing infectious complications. Probes with frequency values between 8 to 13 MHz and 20-, 21-, and 22-gauge needles were the most frequently used at shoulder, knee, wrist, elbow, and ankle level. High-frequency linear probes (ranging between 18 and 22 MHz) and 23- and 25-gauge needles were used for injecting small joints of the hands and feet. Convex low-frequency probe (2-7 MHz) and 18- and 20-gauge needles were the most used for performing hip joint aspirations and/or injections. CONCLUSIONS: This study reports useful information for setting up a service providing US-guided procedures in rheumatology and supports the feasibility, accuracy, and safety of US-guided procedures.

A proposal on how to assess the weight of the subjective components of the DAPSA in patients with psoriatic arthritis and comorbid fibromyalgia syndrome.

OBJECTIVES: To establish the weight of the subjective components of the Disease Activity index for Psoriatic Arthritis (DAPSA) in psoriatic arthritis (PsA) patients and comorbid fibromyalgia syndrome (FM). METHODS: In PsA patients not fulfilling the DAPSA remission, it has been calculated the DAPSA-patient (DAPSA-P), an index represented by the ratio between the sum of the subjective components (tender joint count+patient global assessment of disease activity+visual analogue scale pain) and DAPSA in its entirety (swollen joint count+tender joint count+patient global assessment of disease activity+visual analogue scale pain+C-reactive protein [in mg/ dl]). The DAPSA-P ranges from 0 to 1, and values closer to 1 suggest a major weight of the subjective components, while values closer to 0 indicate a greater contribution of the swollen joint count and C-reactive protein, the two factors more closely related to inflammation. It was also defined as the presence of a comorbid FM, and it was established the DAPSA-P cut-off point distinguishing for the presence of a comorbid FM through the receiver operating characteristic (ROC) curve analysis. RESULTS: DAPSA-P was higher in all PsA+FM patients. Analysing the receiver operating characteristic curve, the DAPSA-P cut-off distinguishing a comorbid FM was 0.775. CONCLUSIONS: DAPSA-P can help to measure how comorbid FM inflates DAPSA.

Ultrasound as a potential tool for the assessment of interstitial lung disease in rheumatic patients. Where are we now?

Lung ultrasound (LUS) achieved an intriguing role in the management of pulmonary involvement in patients affected by connective tissues diseases (CTDs). Few studies have been performed to support its usefulness in the evaluation of the presence and the severity of interstitial lung disease (ILD), relating it to the information obtained with chest high-resolution computed tomography (HRCT). These results open up new fields of research in order to demonstrate the utility of LUS as screening tool to evaluate ILD in CTD. The aim of this review is to provide the "state of the art" of the role of LUS in the management of ILD associated with CTD.

Ultrasound imaging in rheumatoid arthritis.

Over the last decades, ultrasound (US) has undergone a dramatic evolution in the field of inflammatory joint diseases. Rheumatoid arthritis (RA) is probably the pathology that has most benefited from this development, both in terms of early diagnosis and monitoring of disease activity. The RA-induced morpho-structural changes can be effectively detected and measured by US, and US findings represent an additional advantage over clinical and laboratory evaluation, showing the face of the disease (i.e., proliferative synovitis) and revealing its aggressive behavior (i.e., presence of bone erosions not detectable by conventional radiography). The present review provides an overview of the main studies focusing on the value of US in the assessment of the patients with RA, and discussing the elementary lesions detectable by US (synovitis, bone erosion, cartilage damage, tenosynovitis and tendon damage), the scoring systems currently available and the scanning protocols in definite clinical settings (undifferentiated arthritis, early and long standing RA).

Standardization of interstitial lung disease assessment by ultrasound: results from a Delphi process and web-reliability exercise by the OMERACT ultrasound working group.

OBJECTIVES: Over the last years ultrasound has shown to be an important tool for evaluating lung involvement, including interstitial lung disease (ILD) a potentially severe systemic involvement in many rheumatic and musculoskeletal diseases (RMD). Despite the potential sensitivity of the technique the actual use is hampered by the lack of consensual definitions of elementary lesions to be assessed and of the scanning protocol to apply. Within the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group we aimed at developing consensus-based definitions for ultrasound detected ILD findings in RMDs and assessing their reliability in dynamic images. METHODS: Based on the results from a systematic literature review, several findings were identified for defining the presence of ILD by ultrasound (i.e., Am-lines, B-lines, pleural cysts and pleural line irregularity). Therefore, a Delphi survey was conducted among 23 experts in sonography to agree on which findings should be included and on their definitions. Subsequently, a web-reliability exercise was performed to test the reliability of the agreed definitions on video-clips, by using kappa statistics. RESULTS: After three rounds of Delphi an agreement >75 % was obtained to include and define B-lines and pleural line irregularity as elementary lesions to assess. The reliability in the web-based exercise, consisting of 80 video-clips (30 for pleural line irregularity, 50 for B-lines), showed moderate inter-reader reliability for both B-lines (kappa = 0.51) and pleural line irregularity (kappa = 0.58), while intra-reader reliability was good for both B-lines (kappa = 0.72) and pleural line irregularity (kappa = 0.75). CONCLUSION: Consensus-based ultrasound definitions for B-lines and pleural line irregularity were obtained, with moderate to good reliability to detect these lesions using video-clips. The next step will be testing the reliability in patients with ILD linked to RMDs and to propose a consensual and standardized protocol to scan such patients.

Extent and distribution of CPP deposits in patients affected by calcium pyrophosphate dihydrate deposition disease: an ultrasonographic study.

OBJECTIVE: To assess the extent of calcium pyrophosphate dihydrate (CPP) crystal deposition and the distribution of affected sites, using ultrasonography (US), in patients affected by CPP deposition disease (CPPD). PATIENTS AND METHODS: 42 consecutive patients affected by definite CPPD according to the McCarty criteria were enrolled in the study. All patients underwent an US examination of metacarpophalangeal joints of II, III, IV and V fingers of both hands, wrists and knees, Achilles' tendons and plantar fascia looking for CPP deposits. A dichotomous score for presence/absence of CPP and a semiquantitative score for extent of deposits (0-3: 0, absent; 1, 1-2 spots; 2, more than two spots covering <50% of the structure; 3, deposits covering >50% of the structure) were assigned to each site examined. A site distribution score (total number of affected sites) was then calculated as well as an extent score equal to the sum of the extent scores of all sites. RESULTS: The mean involvement in our patients was 4.7 sites (SD±1.7, range 2-8 sites). The knee was the most affected, site (41 of 42) followed by the wrist (at least one in 37 patients) the Achilles' tendons (23 patients), plantar fascia (11 patients) and metacarpophalangeal joints (four patients). The highest mean values of the extent score were in the menisci, followed by the hyaline cartilage of the femoral condyles and the entheses. CONCLUSIONS: The deposition of CPP crystals involves at least two sites with a mean of four sites involved in most patients affected by CPPD and is therefore an oligoarticular or polyarticular disease.

Treatment with COLchicine in hospitalized patients affected by COVID-19: The COLVID-19 trial.

OBJECTIVE: To evaluate whether the addition of colchicine to standard of care (SOC) results in better outcomes in hospitalized patients with COVID-19. DESIGN: This interventional, multicenter, randomized, phase 2 study, evaluated colchicine 1.5 mg/day added to SOC in hospitalized COVID-19 patients (COLVID-19 trial) and 227 patients were recruited. The primary outcome was the rate of critical disease in 30 days defined as need of mechanical ventilation, intensive care unit (ICU), or death. RESULTS: 152 non-anti-SARS-CoV-2-vaccinated patients (colchicine vs controls: 77vs75, mean age 69.1±13.1 vs 67.9±15 years, 39% vs 33.3% females, respectively) were analyzed. There was no difference in co-primary end-points between patients treated with colchicine compared to controls (mechanical ventilation 5.2% vs 4%, ICU 1.3% vs 5.3%, death 9.1% vs 6.7%, overall 11 (14.3%) vs 10 (13.3%) patients, P=ns, respectively). Mean time to discharge was similar (colchicine vs controls 14.1±10.4 vs 14.7±8.1 days). Older age (>60 years, P=0.025), P/F<275 mmHg (P=0.005), AST>40 U/L (P<0.001), pre-existent heart (P=0.02), lung (P=0.003), upper-gastrointestinal (P=0.014), lower-gastrointestinal diseases (P=0.009) and cancer (P=0.008) were predictive of achieving the primary outcome. Diarrhoea (9.1% vs 0%, p=0.0031) and increased levels of AST at 6 days (76.9±91.8 vs 33.5±20.7 U/l, P=0.016) were more frequent in the colchicine group. CONCLUSION: Colchicine did not reduce the rate and the time to the critical stage. Colchicine was relatively safe although adverse hepatic effects require caution. We confirm that older (>60 years) patients with comorbidities are characterized by worse outcome.

Development of a preliminary US power Doppler composite score for monitoring treatment in PsA.

OBJECTIVE: To develop a preliminary power Doppler (PD) US composite score for global assessment of PsA patients. METHODS: Sixteen PsA patients receiving anti-TNF-α therapy were enrolled. All patients were involved in multiple psoriatic targets, including joints, tendon, enthesis, skin and nail. The target with the highest PD signal, one for each target area, was selected to be scanned at baseline and at follow-up visit 8 weeks after. For each target, PD was graded according to semi-quantitative scoring systems. Inter- and intra-observer reliability and feasibility was also investigated. The new PD composite score for PsA was called Five Targets PD for Psoriatic Disease (5TPD). RESULTS: Sixty targets (16 joints, 9 tendons, 11 enthesis, 16 psoriatic plaques and 8 psoriatic onychopathies) were assessed. A significant improvement of the clinical scores was found at follow-up with respect to the baseline: HAQ modified for SpA (HAQ-S) (P = 0.0001); Psoriasis Area and Severity Index (P = 0.0001) and Nail Psoriasis Severity Index (P = 0.35). The 5TPD showed a significant change between baseline and follow-up (P = 0.0001). There was no significant correlation between HAQ-S and 5TPD findings. The inter- and intra-observer κ-values varied from good to excellent at baseline and follow-up. The time spent on baseline US examinations was mean (s.d.) 10.5 (2.0) min and no more than 7 min for follow-up assessment. CONCLUSION: The present study provides a new working hypothesis that the sonographic core set may be useful to construct a PDUS composite score for the assessment of PsA. The 5TPD formula provides a feasible and reliable approach for multi-target monitoring of psoriatic disease.

Reliability of ultrasound measurements of dermal thickness at digits in systemic sclerosis: role of elastosonography.

OBJECTIVES: To investigate the role of elastosonography to improve the reliability of the ultrasound in the measurement of the dermal thickness at finger level in systemic sclerosis (SSc). METHODS: Twenty-two patients with a diagnosis of SSc were consecutively recruited. In all patients at the second finger level of the dominant hand the dorsal aspect of proximal and middle phalanx was assessed in grey-scale and also using the elastosonography by an experienced musculoskeletal sonographer. The first step of the study was directed to explore the correlation between measurements of the dermal thickness using the grey-scale and elastosonography. Subsequently, the intra and the inter-reader reliability (between the sonographer who performed the ultrasound study and another sonographer) in the ultrasound measurements of the dermal thickness was assessed. Intra and inter-reader reliability was calculated using intra-class correlation coefficient (ICC) and illustrated by Bland-Altman plots. RESULTS: The ICC values were 0.904 and 0.979 for the intra-observer agreement, and 0.726 and 0.881 for the inter-observer agreement, using only the grey-scale and also the elastosonography, respectively. An excellent correlation was obtained between measurements in grey-scale and adopting the elastosonography by the experienced sonographer (rho=0.99), while the rho values between the two readers were 0.59 and 0.88, using the conventional technique and also the elastosonography, respectively. CONCLUSIONS: Elastosonography can improve the reliability of the US measurements of the dermal thickness at finger level in patients with SSc, helping for the identification of the interface dermis/hypodermis.

Abatacept in rheumatoid arthritis-associated interstitial lung disease: short-term outcomes and predictors of progression.

INTRODUCTION: Interstitial lung disease in rheumatoid arthritis (RA-ILD) is an extra-articular involvement that impairs the prognosis and for which there is still no well-coded treatment. The aim of this study was to evaluate abatacept (ABA) effectiveness and safety in patients with RA-ILD. METHODS: RA-ILD patients who started ABA treatment were consecutively enrolled. Chest high-resolution computed tomography (HRCT), clinical, laboratory and respiratory function variables were collected at baseline and after 18 months of ABA treatment. HRCT abnormalities were evaluated using a computer-aided method (CaM). ABA response was established based on the change in the percentage of fibrosis evaluated at HRCT-CaM, dividing patients into "worsened" (progression ≥ 15%), "improved" (reduction ≥ 15%), and "stable" (changes within the 15% range). The multivariate regression model was used to assess the associations between RA characteristics and ABA response. RESULTS: Forty-four patients (81% women, mean age 59.1 ± 8.0, mean disease duration of 7.5 ± 3.1 years) were studied. Five patients (11.4%) showed RA-ILD progression, 32 patients (72.6%) were considered stable, and 7 patients (16.0%) showed an RA-ILD improvement. The proportion of current smokers was significantly different between "worsened" patients, respect to those defined as "improved/stable" (p = 0.01). Current smoking habit (p = 0.005) and concomitant methotrexate treatment (p = 0.0078) were the two variables related to RA-ILD progression in multivariate regression analysis. CONCLUSION: Treatment with ABA is associated with a RA-ILD stability or improvement in the 88.6% of patients. Current smoking habit and concomitant treatment with methotrexate are the modifiable factors associated with RA-ILD worsening. Key Points • Abatacept plays a favourable role in the control of RA-ILD, with a significant worsening in only 11.4% of patients during a 18-month follow-up period. • The predictive variables related to RA-ILD progression during abatacept therapy are the concomitant treatment with methotrexate and current smoking habit.

Mild cognitive impairment in psoriatic arthritis: Prevalence and associated factors.

ABSTRACT: To assess the prevalence and factors associated with mild cognitive impairment (MCI) in patients suffering from psoriatic arthritis (PsA).A cross-sectional evaluation was conducted in consecutive PsA patients. Sociodemographic data and the clinimetric variables related to PsA and psoriasis were collected for each patient. MCI was assessed through the Montreal Cognitive Assessment (MoCA). The cognitive performance of PsA patients was compared to healthy subjects using one-way analysis of variance (ANOVA). The correlations among variables were studied by the Spearman rank correlation coefficient. A multivariate logistic regression analysis was carried out to establish the predictors of MCI.The study involved 96 PsA patients and 48 healthy subjects. MCI (defined as a MoCA score < 26/30) was detected in 47 (48.9%) PsA patients. Compared to healthy subjects, the MoCA score resulted significantly lower in PsA patients (P = .015). The main differences involved the denomination and language domains. MoCA was negatively correlated with age (r = -0.354; P < .0001), HAQ-DI (r = -0.227; P = .026), and fatigue (r = -0.222; P = .029), and positively correlated with psoriasis duration (r = 0.316; P = .001) and DLQI (r = 0.226; P = .008).The multivariate logistic regression analysis revealed the duration of psoriasis (P = .0005), age (P = .0038), PASI (P = .0050), and HAQ-DI (P = .0193) as predictors of the MoCA score.MCI is present in a significant proportion of PsA patients, and is mainly determined by age, cutaneous variables, and disability.

Interobserver reliability of ultrasonography in the assessment of cartilage damage in rheumatoid arthritis.

OBJECTIVES: To evaluate the interobserver reliability of ultrasonography (US) in the assessment of cartilage damage at metacarpophalangeal (MCP) joint level in patients with rheumatoid arthritis (RA). METHODS: US examinations were performed on 80 MCP joints of 20 patients with RA using a MyLab70 XVG (Esaote Biomedica, Genoa, Italy), equipped with a broadband linear probe (6-18 MHz). For each patient, second and third MCP joints of both hands were examined independently on the same day by two rheumatologists (an experienced musculoskeletal sonographer and an investigator with limited US training). A multiplanar scanning technique on dorsal, lateral and volar aspects of the MCP joints was adopted. All US pathological findings were documented on at least two perpendicular scanning planes. Each joint was assessed by quadrant for the presence or absence of cartilage damage. Cartilage damage was also scored per quadrant on a five-grade semiquantitative scoring system on which investigators reached a consensus prior to the study. RESULTS: Exact agreement between investigators was found in 173 out of 200 quadrants (86.5%) with regard to presence or absence of cartilage damage. Percentages of exact agreement for cartilage damage semiquantitative assessment at dorsal, lateral and volar quadrants were 72.5%, 52.5% and 85%, respectively, while unweighted κ values were 0.561, 0.366 and 0.766, respectively. CONCLUSIONS: The present study demonstrated moderate to good interobserver reproducibility of a semiquantitative scoring system based on qualitative morphological changes for cartilage damage at MCP joint level in patients with RA.

Computed tomography assessment of evolution of interstitial lung disease in systemic sclerosis: Comparison of two scoring systems.

BACKGROUND: The aim of this study was to evaluate and compare the internal and external responsiveness of a computed-aided method (CaM) with a conventional visual reader-based score (CoVR) to measure interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) on high resolution computed tomography (HRCT). METHODS: Forty-five patients were evaluated in this retrospective cohort. HRCTs were collected at baseline and after 1 year. HRCT abnormalities were evaluated according to a CoVR (Warrick's method) and a quantitative CaM. Internal 1-year responsiveness was tested with a standardized mean response (SRM). Analyses of the receiver operating characteristic curves (ROCs) evaluated the sensitivity and specificity of the two methods to discriminate between clinically relevant progression and no relevant progression, using expert judgment as the gold standard (external responsiveness). RESULTS: In one year, lung involvement was stable/improved in 17 of the 45 patients (37.8%) and worsened in 28 patients (62.2%). HRCT scores changed moderately over the follow-up period. Using SFM, CaM was significantly more responsive in detecting changes due to treatment than the CoVR method. Likewise, in the analysis of the ROC curve, CaM scores showed the highest performance (AUC ROC CaM vs. CoVR, 0.951 vs. 0.807; p = 0.0065). CONCLUSION: Quantitative analysis of CaM was more responsive than the CoVR method to accurately evaluate and monitor SSc-ILD progression or response to therapy.

The role of a chest computed tomography severity score in coronavirus disease 2019 pneumonia.

The chest computed tomography (CT) characteristics of coronavirus disease 2019 (COVID-19) are important for diagnostic and prognostic purposes. The aim of this study was to investigate chest CT findings in COVID-19 patients in order to determine the optimal cut-off value of a CT severity score that can be considered a potential prognostic indicator of a severe/critical outcome.The CT findings were evaluated by means of a severity score that included the extent (0-4 grading scale) and nature (0-4 grading scale) of CT abnormalities. The images were evaluated at 3 levels bilaterally. A receiver operating characteristics (ROC) curve was used to identify the optimal score (Youden's index) predicting severe/critical COVID-19.The study involved 165 COVID-19 patients (131 men [79.4%] and 34 women [20.6%] with a mean age of 61.5 ±â€Š12.5 years), of whom 30 (18.2%) had severe/critical disease and 135 (81.8%) mild/typical disease. The most frequent CT finding was bilateral predominantly subpleural and basilar airspace changes, with more extensive ground-glass opacities than consolidation. CT findings of consolidation, a crazy-paving pattern, linear opacities, air bronchogram, and extrapulmonary lesions correlated with severe/critical COVID-19. The mean CT severity score was 63.95 in the severe/critical group, and 35.62 in the mild/typical group (P < .001). ROC curve analysis showed that a CT severity score of 38 predicted the development of severe/critical symptoms.A CT severity score can help the risk stratification of COVID-19 patients.

High-resolution computed tomography of the lung in patients with rheumatoid arthritis: Prevalence of interstitial lung disease involvement and determinants of abnormalities.

An international consensus for rheumatoid arthritis (RA) patients at risk of developing interstitial lung disease (ILD) is still lacking. The aims of study were to evaluate: the prevalence of ILD involvement in RA over high-resolution computed tomography (HRCT); the relationships between pulmonary function tests (PFTs), patient-centered measurements, and ILD; and the potential risk factors contributing to RA-ILD patients.Data regarding the clinical characteristics (age, sex, age at onset of RA), laboratory findings (rheumatoid factor [RF] and anti-citrullinated protein antibodies [ACPA]), respiratory functional assessment (forced vital capacity [FVC] and carbon monoxide diffusion capacity [DLCO]), patient-centred measures of dyspnea (PCMD), Health Assessment Questionnaire-Disability Index (HAQ-DI), and HRCT have collected retrospectively. HRCT abnormalities were evaluated using a conventional visual reader-based score (CoVR) and a computer-aided method (CaM). The relationships between the 2 HRCT scores-PFTs and PCMD-were calculated using Pearson correlation. The area under the receiving-operating characteristic (AUC-ROC) curve was calculated to determine the discriminatory performance of measurements between patients with and without ILD. The multivariate regression model was used to evaluate the association force between ILD and RA characteristics.In all, 151 patients (45 males and 106 females, mean age 53.4 ±â€Š7.6 years) were included. ILD had been detected in 29 patients out of 151 (19.2%). Usual interstitial pneumonia was the most common HRCT. RA-ILD patients were older, and older at RA onset (both P < .01), with a higher HAQ-DI (P < .05) than patients without ILD. ACPA positivity and titer were higher in the RA-ILD group (P = .02). Extent and severity of ILD, and total CoVR and CaM score closely related to DLCO and PCMD (both P < .0001). A reduced DLCO was the most sensitive test for predicting the presence of ILD on HRCT (AUC-ROC 0.811 ±â€Š0.037). Advanced age (P < .0001), age at RA onset (P = .025), ACPA titer (P = .004), and smoking (P = .008) were independent explanatory variables of HRCT damage in multivariate analysis.The RA-ILD is associated with age and older age of RA onset, smoking, and ACPA titer. DLCO seems to be the most sensitive parameter to predict ILD on HRCT, followed by PCMD.

Ultrasound B-lines in the evaluation of interstitial lung disease in patients with systemic sclerosis: Cut-off point definition for the presence of significant pulmonary fibrosis.

The aim of this study was to establish the cut-off point of ultrasound (US) B-lines number for detecting the presence of significant interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) (SSc-ILD) in relation to high-resolution computed tomography (HRCT) findings.Consecutive SSc-ILD patients underwent chest HRCT, lung US (LUS), pulmonary function test, and clinical assessment. Exclusion criteria were represented by the presence of a coexisting congestive heart failure and a clinical history suggestive of lung or pleural diseases. HRCT images were scored for the presence of ILD by 2 readers, in accordance with the Warrick scoring system. US assessment was performed by a US skilled rheumatologist, blinded to HRCT results and clinical data, and included the bilateral evaluation of 14 lung intercostal spaces (LIS). In each LIS, the number of B-lines was recorded and summed. To test discriminant validity, we used the receiver operating characteristic (ROC) curve analysis applying a Warrick score of 7 as external criterion for the presence of SSc-ILD.Forty patients completed the study. The US B-lines number and the Warrick score confirmed excellent correlation (Spearman rho: 0.958, P = .0001). The ROC curve analysis revealed that the presence of 10 US B-lines is the cut-off point with the greatest positive likelihood ratio (12.52) for the presence of significant SSc-ILD.The detection of 10 B-lines is highly predictive for the HRCT presence of significant SSc-ILD. In SSc patients, the LUS assessment as first imaging tool may represent an effective model to improve the correct timing of chest HRCT.

The Expanded Risk Score in Rheumatoid Arthritis (ERS-RA): performance of a disease-specific calculator in comparison with the traditional prediction scores in the assessment of the 10-year risk of cardiovascular disease in patients with rheumatoid arthrit.

AIMS OF THE STUDY: To assess the performance of the Expanded Risk Score in Rheumatoid Arthritis (ERS-RA), a disease-specific cardiovascular disease (CVD) prediction score, in evaluating the 10-year risk, in comparison with other traditional algorithms in patients with rheumatoid arthritis (RA). METHODS: Consecutive RA patients, aged 40-75 years, without established CVD, were included. We calculated the disease-specific ERS-RA and four traditional CVD prediction scores: the modified Systematic Coronary Risk Evaluation (mSCORE), the Framingham Risk Score using body mass index (FRS BMI), the calculator developed by the American College of Cardiology / American Heart Association in 2013 (ACC/AHA 2013) and the QRISK3. Subjects also underwent ultrasound assessment of the carotid arteries. The presence of a carotid intima-media thickness (CIMT) >0.90 mm or of carotid plaques identified the high-risk patients. RESULTS: Of the 84 patients evaluated, 33 (39.3%), 16 (19.0%), 24 (28.6%), 25 (29.8%) and 33 (39.3%) subjects were defined as having high CVD risk according to ACC/AHA 2013, mSCORE, FRS BMI, QRISK3 and ERS-RA, respectively. Compared with the ultrasound results, all the areas under the receiver operating characteristic curves (AUC-ROC) showed good discrimination properties (0.848 - FRS BMI, 0.816 - mSCORE, 0.828 - ACC/AHA 2013, 0.844 - QRISK3, 0.869 - ESR-RA). Comparison of the AUC-ROCs did not show that discriminative ability for detecting subclinical atherosclerotic damage was improved with ESR-RA. CONCLUSIONS: Using a surrogate marker of subclinical atherosclerotic organ damage as indicator of CVD burden, the newly ERS-RA risk score that incorporates specific aspects of RA performs as well as ACC/AHA 2013, mSCORE, FRS BMI and QRISK3 estimators.