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Lung ultrasound as part of a diagnostic algorithm to detect interstitial lung disease in rheumatoid arthritis patients at risk

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12

 

  1. Rheumatology and Clinical Immunology Unit, Attikon University Hospital, National Kapodistrian University of Athens Medical School, Athens, Greece.
  2. 5th Department of Pulmonary Medicine, Sotiria General Hospital, Athens, Greece.
  3. Rheumatology and Clinical Immunology Unit, Attikon University Hospital, National Kapodistrian University of Athens Medical School, Athens, Greece.
  4. 2nd Pulmonary Medicine Department, Attikon University Hospital, National Kapodistrian University of Athens Medical School, Athens, Greece.
  5. 2nd Department of Radiology, Attikon University Hospital, National Kapodistrian University of Athens Medical School, Athens, Greece.
  6. Rheumatology and Clinical Immunology Unit, Attikon University Hospital, National Kapodistrian University of Athens Medical School, Athens, Greece.
  7. 2nd Pulmonary Medicine Department, Attikon University Hospital, National Kapodistrian University of Athens Medical School, Athens, Greece.
  8. 2nd Department of Radiology, Attikon University Hospital, National Kapodistrian University of Athens Medical School, Athens, Greece.
  9. Rheumatology and Clinical Immunology Unit, Attikon University Hospital, National Kapodistrian University of Athens Medical School, Athens, Greece.
  10. 2nd Pulmonary Medicine Department, Attikon University Hospital, National Kapodistrian University of Athens Medical School, Athens, Greece.
  11. Rheumatology and Clinical Immunology Unit, Attikon University Hospital, National Kapodistrian University of Athens Medical School, Athens, Greece.
  12. Rheumatology and Clinical Immunology Unit, Attikon University Hospital, National Kapodistrian University of Athens Medical School, Athens, Greece. afanour@med.uoa.gr

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PMID: 42873714 [PubMed]

Received: 05/03/2026
Accepted : 15/06/2026
In Press: 14/10/2026

Abstract

OBJECTIVES:
Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) affects 5–10% of patients with RA. While lung ultrasound (LUS) shows promise for RA-ILD detection, its role remains inconclusive. We aimed to assess its performance as a screening tool in at-risk RA patients.
METHODS:
We made a cross-sectional study of RA patients, including i) individuals >50 years old with ≥1 risk factor for ILD, and ii) patients with new-onset respiratory symptoms. All patients underwent clinical examination, pulmonary function testing (PFT), LUS, and chest high-resolution computed tomography (HRCT). LUS was considered abnormal in case of ≥5 total B-lines, and diagnostic accuracy was compared against HRCT, using a recent American Thoracic Society definition.
RESULTS:
We included 103 RA patients (73% women; mean age 63.4 years, median disease duration 7 years, 62% current or ever smokers, 68% seropositive for RF and/or ACPA). The majority (67 patients, 64.4%) reported no respiratory symptoms and had normal lung auscultation. According to ATS definition, 23 patients (22.3%) had ILD. Use of LUS for RA-ILD showed a sensitivity of 60.9% (95% CI: 40.8–77.8%), specificity of 63.7% (95% CI: 52.8–73.4%), and a negative predictive value (NPV) of 85% (95% CI: 73.9–91.9%). In regression and random forest analyses, LUS did not outperform DLCO for the prediction of RA-ILD. However, combination of negative LUS examination with normal DLCO essentially excluded RA-ILD (NPV 100%, 95%CI: 82–100%).
CONCLUSIONS:
Negative LUS in combination with normal DLCO reliably exclude ILD in at-risk RA patients, supporting its role in early RA-ILD detection.

DOI: https://doi.org/10.55563/clinexprheumatol/xgirav

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