Thoracic ultrasound: a new diagnostic imaging tool in RA-ILD?

The AURORA study aims to determine whether thoracic ultrasound can be used compared with the current reference standard, high-resolution computed tomography (HCRT), to accurately diagnose interstitial lung disease (ILD) in rheumatoid arthritis (RA) patients with respiratory symptoms.

Dr Bjørk Sofíudóttir (University of South Denmark, Denmark) pointed out that point-of-care thoracic ultrasound may offer an interesting option to assess ILD as the current method to diagnose ILD is HCRT (in combination with lung physiological parameters). Dr Sofíudóttir summed up the potential advantages of thoracic ultrasound imaging including the fact that it is radiation-free, minimally time-consuming, as well as cheap and easily applicable during out-patient consultation which allows for feasible implementation and direct read-outs. She also mentioned that there is a strong tradition in rheumatology when it comes to using ultrasound. Potential drawbacks include the highly examiner-dependent nature of the method and limited visualisation of the intra-thoracic structures and hence, more central pathologies may be missed. Furthermore, the method precludes detection of common chronic airway diseases such as COPD or asthma.

The primary objective of the AURORA study (NCT05396469) is to assess whether thoracic ultrasound can reliably detect RA-ILD and can serve as a screening tool in the outpatient setting. Using a 14-zone protocol for ILD in RA patients with respiratory symptoms, this study compares diagnostic accuracy of thoracic ultrasound with chest HRCT as the reference standard. Additional study objectives include the assessment of the diagnostic potential of blood biomarkers (surfactant protein-D and microfibrillar-associated protein 4) in the detection of ILD in this study population.

Researchers aim to include 80 RA patients aged ≥18 years, diagnosed with RA (according to the 2010 ACR criteria for RA) with respiratory symptoms indicative of RA-ILD (i.e. experiencing at least one of the following symptoms: unexplained dyspnoea, unexplained cough, and/or residual pneumonia, or a chest X-ray showing interstitial abnormalities of the lung). The study has just been initiated and it aims to be completed in January 2024 [1].

1. Sofíudóttir B, et al. Detection of rheumatoid arthritis-associated ILD by ultrasound of the lung. Nordic Lung Congress 2022, 01–03 Jun, Copenhagen, Denmark.

 

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Posted on 17 August, 202216 August, 2022