Lung ultrasound B-lines can depict modifications in the lung parenchyma of patients with systemic sclerosis (SSc) and may be an independent predictor of additional pulmonary deterioration in individuals with the disease, according to the results of an analysis published in CHEST. Results of the analysis were published in CHEST.
Researchers conducted a prospective study in consecutive patients with SSc who were enrolled at 3 rheumatology departments in Italy and were evaluated during their routine office visits. Recognizing that a high percentage of patients with SSc go on to develop interstitial lung disease (ILD) and that the evaluation of lung ultrasound B-lines can help assess ILD, the investigators sought to establish the prognostic value of B-lines in this patient population. The primary study outcome was the combination of development of ILD or worsening of preexisting ILD.
Criteria for study inclusion were as follows: prior diagnosis of SSc, based on American College of Rheumatology/European League Against Rheumatism guidelines, independent from disease stage and organ involvement; age >18 years; informed consent; and the availability for follow-up. All participants underwent a comprehensive lung ultrasound examination on the anterolateral and posterior chest, for an overall total of 58 scanning sites. The researchers recorded all of the available clinical, functional, and imaging data. All of the participants were followed up after enrollment to determine the prognostic role played by lung ultrasound.
A total of 396 consecutive patients with SSc met the inclusion criteria and were enrolled in the study. The median patient age was 55 years (range, 44-66 years); 365 of the participants were women and 31 were men. The median disease duration was 4 years (interquartile range, 1-9 years). Overall, the diffuse skin subset was reported in 22.5% of the participants, with a prevalence of digital ulcers of 32.6% and a prevalence of ILD on high-resolution computed tomography (HRCT) of 42.2%.
Results showed that the median number of B-lines was significantly higher in patients with the diffuse cutaneous subset (44 vs 17; P <.0001), those with topoisomerase I autoantibodies (39 vs 16; P <.0001), and individuals who exhibited ILD on chest HRCT (45 vs 9; P <.0001). On multivariable analysis, the number of posterior B-lines ≥5 was significantly associated with either new development or worsening ILD (hazard ratio [HR], 3.378; 95% CI, 1.137-9.994; P =.028). The prognostic value of lung ultrasound B-lines was validated further in the subgroup of participants with known ILD at baseline (HR, 1.010; 95% CI, 1.003-1.018; P =.008).
The investigators concluded that in the near future, the use of lung ultrasound could become part of the prognostic and diagnostic armamentarium in patients with SSc, thus enabling a more user-friendly approach to the treatment of this patient population.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Gargani L, Bruni C, Romei C, et al. Prognostic value of lung ultrasound B-lines in systemic sclerosis [published online April 28, 2020]. CHEST. doi:10.1016/j.chest.2020.03.075