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Multicenter Study
. 2025 Jun;167(6):1687-1695.
doi: 10.1016/j.chest.2024.11.038. Epub 2024 Dec 13.

Performance of Lung Ultrasound as a Screening Tool for Subclinical Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Multicenter Study

Maria Otaola  1 , Eirini Vasarmidi  2 , Sébastien Ottaviani  3 , Marwin Gutierrez  4 , Marina Soledad Dalpiaz  5 , Adrian Gaser  6 , Pierre-Antoine Juge  3 , Chiara Bertolazzi  4 , Nestor Avgoustidis  7 , Christos Skiadas  8 , Maricel Della Maggiora  5 , Paola Orausclio  9 , Alan Quintana-Rodriguez  10 , Marie-Pierre Debray  11 , Barbara Perez Cepas  5 , Emilce Schneeberger  12 , Prodromos Sidiropoulos  7 , Nicolas Lloves Schenone  5 , Marcos Rosemffet  12 , Sebastian Marciano  13 , Katerina Antoniou  2
Affiliations
Multicenter Study

Performance of Lung Ultrasound as a Screening Tool for Subclinical Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Multicenter Study

Maria Otaola et al. Chest. 2025 Jun.

Abstract

Background: The screening strategy for interstitial lung disease (ILD) in patients with rheumatoid arthritis is currently debated. Although high-resolution CT (HRCT) imaging is the gold standard for diagnosing ILD, its systematic use as a screening tool is not yet recommended. The role of lung ultrasound (LUS) in assessing ILD has been previously explored.

Research question: What is the performance of LUS for ILD diagnosis in asymptomatic patients with rheumatoid arthritis?

Study design and methods: We conducted a multicenter, cross-sectional study involving 203 asymptomatic patients with rheumatoid arthritis from outpatient clinics in Argentina, Greece, France, and Mexico. Participants underwent clinical evaluations, pulmonary function tests, and LUS. An HRCT scan was performed on each patient within 30 days of the LUS. Statistical analyses included sensitivity, specificity, and predictive values for LUS and pulmonary function tests.

Results: Of the participants, 26% were diagnosed with ILD. The median age was 63 years (52-89 years), and 161 (79.3%) patients were female. The median duration from rheumatoid arthritis diagnosis to inclusion was 7 years (range, 2-16 years). LUS exhibited a sensitivity of 83% (95% CI, 70.2%-91.9%) and a specificity of 81.2% (95% CI, 74.2%-87.2%), with a negative predictive value of 93.1% (95% CI, 87.4%-96.8%) and a positive predictive value of 61.1% (95% CI, 58.9%-72.4%). LUS outperformed pulmonary function tests, underscoring its potential as a primary screening tool.

Interpretation: Our results suggest that LUS is a promising tool for ILD screening in asymptomatic patients with rheumatoid arthritis, offering high sensitivity and negative predictive value. Its incorporation into routine clinical practice could optimize ILD screening strategies and enhance patient outcomes through early detection and intervention.

Keywords: interstitial lung disease; lung ultrasound; rheumatoid arthritis; screening.

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Conflict of interest statement

Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: M. O. advises Boehringer Ingelheim; and is on the speakers bureau of Boehringer Ingelheim, Bristol Myers Squibb, and Raffo. M. R. is on the speakers bureau for AbbVie, Pfizer, Raffo, and Novartis. E. S. consults for AbbVie, Bristol Myers Squibb, Boehringer Ingelheim, and Novartis; and is on the speakers bureau for AbbVie, Boehringer Ingelheim, and Novartis. M. G. has attended advisory board meetings and scientific consultancies and has obtained speaking fees for AbbVie, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Esaote S.p.a., Janssen, Lilly, Novartis, Merck Sharp & Dohme, MegaLabs, Roche, PeruLab, Pfizer, Procaps, and UCB. N. A. has obtained support for attending meetings from BMS and Biocon Biologic. K. A. has attended advisory board meetings and scientific consultancies for Boehringer Ingelheim, F. Hoffmann-La Roche Ltd, and GlaxoSmithKline; and is on the speakers bureau of AstraZeneca, Boehringer Ingelheim, F. Hoffmann-La Roche Ltd, GlaxoSmithKline, Menarini, and Chiesi. P. S. has obtained a grant from Novartis and support for attending meetings from Jansen; and is on the speakers bureau of AbbVie, MSD, Pfizer, Novartis, UCB and Lilly. None declared (E. V., S. O., M. S. D., A. G., P.-A. J., C. B., C. K., M. M. D., P. O., A. Q.-R., M.-P. D, B. P. C., N. L. S., S. M.).

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