Lung Ultrasound Predicts Progression of Interstitial Lung Abnormalities in Rheumatoid Arthritis

Interstitial lung abnormalities are a pulmonary concern in patients with rheumatoid arthritis, requiring monitoring to detect disease progression. However, tracking these changes often involves repeated high-resolution computed tomography scans, highlighting the need for alternative assessment methods. A new study suggests that lung ultrasound may help predict the progression of these abnormalities, potentially supporting more targeted monitoring of patients with rheumatoid arthritis.

Researchers at KU Leuven (Belgium) evaluated lung ultrasound as a tool for monitoring the progression and development of interstitial lung abnormalities in patients with rheumatoid arthritis. The study used a 72-zone lung ultrasound protocol to measure B-lines, which can indicate changes in lung tissue. Patients underwent lung ultrasound, high-resolution computed tomography (HRCT), pulmonary function testing, and symptom assessment at baseline and again after 12 to 18 months. Radiologic progression was determined by comparing HRCT findings over time.

The study included 81 patients who completed follow-up HRCT, of whom 77 also underwent lung ultrasound according to the study protocol. Radiologic progression was observed in 31% of patients, with increases in B-lines showing a significant association with worsening lung abnormalities. Researchers also confirmed a linear relationship between changes in B-lines and radiologic progression.

To evaluate predictive performance, researchers developed six multivariable logistic regression models combining lung ultrasound measurements, pulmonary function tests, symptoms, and clinical characteristics. Baseline B-line counts and changes over time significantly predicted radiologic progression, achieving an area under the curve (AUC) of 0.78. Adding changes in diffusing capacity for carbon monoxide improved the AUC to 0.82.

The lung ultrasound-based model outperformed symptom scores and pulmonary function tests, which achieved AUC values of 0.58 and 0.59, respectively. Published in the November issue of Arthritis & Rheumatology, the findings suggest that lung ultrasound could provide a useful tool for monitoring interstitial lung abnormalities in rheumatoid arthritis, although further validation is needed.

“LUS may aid in detecting radiologic progression and the appearance of new development of ILAs. This pilot study provides a foundation for future research to validate the observed correlation with radiologic progression,” the study authors wrote.

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