Seropositive rheumatoid arthritis (RA) is associated with cardiovascular and pulmonary comorbidity, but screening for early detection of organ manifestation especially interstitial lung disease (ILD) is not established in RA.
We screened consecutive patients with sero- and ACPA-positive RA according to the 2010 ACR-/EULAR- RA classification criteria, but without symptoms for or known cardiopulmonary disease.
We used a noninvasive radiation-free approach to screen for pulmonary, pleural or vascular manifestation of the disease by means of pulmonary function test (PFT), cardiopulmonary exercise test (CPET), echocardiography and pleuro- pulmonary transthoracic ultrasound (LUS). ILD was suspected with signs on LUS and additional PTF changes. The study was approved by the ethical committee of the University of Munich.
We included 45 patients (82% female, mean age 60 +/- 12, 40% active or previous smokers). We found 34% of patients with DLCOc- SB ? 80%, and 7% with FVC ? 80%. In 39% of patients, we found noticeable changes in LUS, 23% with a ILD compatible pattern. LUS and PFT changes were present in 13% of patients.
Other findings included tumor suspected pleural consolidation on LUS (n=1), severe aortic stenosis (n=1), severe impaired diffusion capacity due to lung emphysema (n=1), small pleural effusion (n=3), and obstructive lung disease (n=2). None of the patients showed signs of pulmonary vascular involvement or cardiac ischemia on echocardiography or CPET.
Conclusion: Screening of asymptomatic sero- and ACPA-positive RA patients for pulmonary involvement detects a variety of cardiopulmonary comorbidities. ILD was suspected in 13% of cases.