Lung ultrasound is a promising screening tool to rule out interstitial lung disease in patients with rheumatoid arthritis.

BACKGROUND AND OBJECTIVE: It is still controversial how to screen for interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA). We aimed to evaluate the performance of lung ultrasound (LUS) as a screening tool for RA-ILD and to compare it with the performance of chest auscultation, chest x-ray and pulmonary function tests (PFTs). METHODS: Cross-sectional study of consecutive RA patients evaluated at a Rheumatology Clinic in Buenos Aires between January and December 2022. High-resolution computed tomography (HRCT) was the gold standard for diagnosing ILD and was performed within 30 days of the LUS, chest x-ray and PFTs. Investigators were blinded to HRCT results and patients' clinical data. LUS was performed by exploring 14 areas and was considered positive when the sum of B lines was ≥5. Performance for the diagnosis of ILD was reported for each diagnostic test. RESULTS: One hundred and six patients were included; 87 (82%) were women. Median age was 60.9 (±9.5) years-old. A total of 32 (30.2%, 95% CI: 21.6%-39.9%) had ILD. The sensitivity and negative predictive value of LUS were 90.6% (95% CI 75.0%-98.0%) and 94.7% (95% CI 85.4%-98.9%), respectively. LUS performance was superior to that of the other evaluated diagnostic tests for screening ILD. CONCLUSIONS: Given that the US is a low-cost point-of-care tool with a high negative predictive value, it is emerging as a valuable tool for ruling out ILD in patients with RA.

Is entheses ultrasound reliable? A reading Latin American exercise.

The objective of this study is to evaluate inter-reader entheses ultrasound (US) reliability and the influence of the type of image or degree of sonographer experience on US reliability in patients with spondyloarthritis (SpA). Eighteen Latin American ultrasonographers with different experience took part in an US reading exercise evaluating 60 entheseal images (50 % static images and 50 % videos) from healthy controls and SpA patients. The following sonographic lesions were assessed: structure, thickness, bone proliferation/tendon calcification, erosions, bursitis, and Doppler signal. Another group of three experts with significant experience in entheses US read all images too. Inter-reader reliability among participants and experts was calculated by the Cohen's kappa coefficient. Thresholds for kappa values were <0.2 poor, 0.21-0.4 fair, 0.41-0.6 moderate, 0.61-0.8 good, and 0.81-1 excellent. Furthermore, the results for the expert group were stratified based on the type of image. Kappa correlation coefficients among participants, showed variability depending on the type of lesion, being fair for structure and thickness, moderate for calcifications, erosions, and bursitis, and excellent for Doppler signal. Inter-reader reliability among experts was higher, being moderate for structure and thickness, good for calcifications and bursitis, and excellent for erosions and Doppler. Inter-reader reliability for assessing calcification and structure using static images was significantly higher than for videos. Overall inter-reader reliability for assessing entheses by US in SpA is moderate to excellent for most of the lesions. However, special training seems fundamental to achieve better inter-reader reliability. Moreover, the type of image influenced these results, where evaluation of entheses by videos was more difficult than by static images.

Validación del índice compuesto DAPSA (Disease Activity for Psoriatic Arthritis) en una cohorte de pacientes con artritis psoriásica en Argentina y determinación de sus valores de corte / Validation of the composite index DAPSA (Disease Activity for Psoriatic Arthritis) in a cohort of patients with psoriasis arthritis in Argentina and determination of their cut-off values

Objetivos: Validar el índice DAPSA en pacientes con Artritis Psoriásica (APs) en Argentina, comparar su rendimiento con índices compuestos y con la ultrasonografía (US) y establecer valores de corte. Materiales y Métodos: Se incluyeron pacientes con APs según criterios CASPAR. En 10 pacientes se realizó recuento ecográfico de articulaciones tumefactas (66) y se calculó un DAPSA ecográfico. Para establecer valores de corte se realizó la valoración de los estados de actividad de la enfermedad por 10 reumatólogos a través 20 casos hipotéticos de pacientes con APs y según los valores de corte del SDAI. Resultados: Se incluyeron 112 pacientes. DAPSA m14,3 (RIC 7-22,4). DAPSA presentó muy buena correlación con DAS28 (Rho:0,85), IAS (Rho:0,94), CDAI (Rho:0,95), SDAI (Rho:0,94) y N° de articulaciones dolorosas (Rho:0,84). DAPSA ecográfico m10,6 (RIC 8,5-17,9) presentó muy buena correlación con DAPSA (Rho:0,94). Usando los valores de corte del SDAI, elaboramos curvas ROC para establecer los valores de corte del DAPSA: ≤3,5 remisión, >3,5 a ≤13,4 baja, >13,4 a ≤26,2 moderada y >26,2 alta actividad (sensibilidad y especificidad ≥90%, área bajo la curva de 98%). Conclusión: Los valores de corte propuestos permitieron definir los diferentes estados de actividad de la enfermedad con muy buena sensibilidad y especificidad.

Objective: To validate DAPSA in patients with PsA in Argentina, evaluate its performance using other indexes, the ultrasound and establish tentative cut-off values according to disease activity. Methods: Patients with PsA according to CASPAR criteria. DAS28, DAPSA, SDAI, CDAI, and CPDAI were calculated. In 10 patients we assessed swollen joints (66) by ultrasound and calculated an ultrasound DAPSA. We tried to establish cut-off values through: the assessment of disease activity states by 10 rheumatologists through 20 hypothetical cases of patients with PsA and according to SDAI cut-off points. Finally, we validated DAPSA cut-off values in the RAPSODIA cohort. Results: We included 112 patients. DAPSA m14.3 (IQR 7-22.4). DAPSA had excellent correlation with DAS28 (Rho:0.85), CDAI (Rho:0.95), SDAI (Rho:0.94) and tender joint count (Rho:0.84). Ultrasound DAPSA m10.6 (IQR 8.5-17.9), it had excellent correlation with DAPSA (Rho:0.94). Using established cut-off values for SDAI, we performed ROC curves for DAPSA's cut-off values: ≤3.5 remission, >3.5 to ≤13.4 low, >13.4 to ≤26.2 moderate, and >26.2 high disease activity (sensitivity and specificity ≥90%, area under the curve of 98%). Conclusion: With these cut-off values is possible to define different disease activity states with a very good sensitivity and specificity.

Comparación entre test de squeeze positivo y hallazgos ecográficos en pacientes con artritis reumatoidea / Comparison between positive squeeze test and ultrasound findings in patients

Objetivos: Evaluar si existe una asociación entre el test de Squeeze (TS) positivo y el hallazgo ecográfico de sinovitis en las articulaciones metacarpofalángicas (MCF) y metatarsofálangicas (MTF) de pacientescon diagnóstico de artritis reumatoidea (AR). Resultados: Se evaluaron 35 pacientes con diagnóstico de AR, 85% mujeres, con una mediana de edad de 57 años (RIC 50,5-64), y una mediana de tiempo de evolución de 10 años (RIC 4-15). La sensibilidad (S) y especificidad (E) del test de Squeeze para detectar al menos una MCF dolorosa fue de 81% y 90%, respectivamente. Para detectarinflamación en MCF, el test tuvo una S de 62% y una E de 78%. En pies, el test presentó un menor desempeño, con S y E menores. En la evaluación ecográfica de pacientes con TS positivo se observó una mayor frecuencia de hipertrofia sinovial, distensión articular y señal Doppler en manos, e hipertrofia sinovial y distensión articular en pies. Sin embargo, ninguno de estos hallazgos alcanzó significancia estadística. El test de Squeeze en manos tuvo una S de 50% y E de 84% para detectar señal Doppler. Conclusiones: El test de Squeeze demostró ser útil para detectar articulaciones dolorosas, especialmente en las manos. En este estudio no se encontró una asociación significativa con hallazgos ecográficos. La sensibilidad del test en manos y pies para detectar efecto Doppler no fue buena, pero la especificidad fue aceptable.

Objectives: To assess whether a association exists between thepositive Squeeze test (ST) and ultrasound finding of synovitis in themetacarpophalangeal (MCP) and metatarsophalangeal (MTP) of patientswith rheumatoid arthritis (RA). Results: We evaluated 35 patients with RA, 85% were female, with a median age of 57 years (IQR 50.5-64) and a median disease duration of 10 years (IQR 4-15). The sensitivity (S) and specificity (Sp) for the Squeeze test in detecting at least one painful MCP was 81% and 90%, respectively. To detect inflammation in MCP joints, the testhad a sensitivity of 62% and a specificity of 78%. The test showeda worse performance in feet, with less S and Sp. In the ultrasonographicevaluation of patients with positive TS, we found a higher frequency of synovial hypertrophy, distension and Doppler signal in hands, and synovial hypertrophy and distension in feet. However, none of these findings reached statistical significance. Squeeze test in hands had a S of 50% and Sp of 84% to detect Doppler. Conclusions: The Squeeze test proved to be useful in detecting painful joints, especially in hands. This study found no significantassociation with ultrasound findings. The sensitivity of the test to detect Doppler was not good, but the specificity was acceptable.