The role of lung ultrasound B-lines and serum KL-6 in the screening and follow-up of rheumatoid arthritis patients for an identification of interstitial lung disease: review of the literature, proposal for a preliminary algorithm, and clinical application to cases

Arthritis Research & Therapy

Marco Matucci-Cerinic¹  Daniel E. Furst²  Guohong Zhang³  Guangzhou Du⁴  Shaoyu Zheng⁵  Qisheng Lin⁵  Jianqun Lin⁵  Shijian Hu⁵  Weijin Zhang⁵  Xuezhen Xie⁵  Kedi Zheng⁵  Jinghua Zhuang⁵  Yukai Wang⁶  Anna-Maria Hoffmann-Vold⁷  Shaoqi Chen⁸ 

[1] Department of Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy;Department of Geriatric Medicine, Division of Rheumatology, AOUC, Florence, Italy;Department of Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy;Department of Geriatric Medicine, Division of Rheumatology, AOUC, Florence, Italy;Division of Rheumatology, Department of Medicine, University of California at Los Angeles, Los Angeles, USA;Department of Pathology, Shantou University Medical College, Shantou, Guangdong, China;Department of Radiology, Shantou Central Hospital, Shantou, Guangdong, China;Department of Rheumatology and Immunology, Shantou Central Hospital, Shantou, Guangdong, China;Department of Rheumatology and Immunology, Shantou Central Hospital, Shantou, Guangdong, China;Department of Experimental and Clinical Medicine & Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy;Department of Geriatric Medicine, Division of Rheumatology, AOUC, Florence, Italy;Department of Rheumatology, Oslo University Hospital, Oslo, Norway;Department of Ultrasound, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China;

关键词: Lung ultrasound;    B-lines;    KL-6;    High-resolution computed tomography;    Pulmonary function tests;    Rheumatoid arthritis–associated interstitial lung disease;    Screen;    Follow up;   

DOI  :  10.1186/s13075-021-02586-9

来源: Springer

【 摘 要 】

Screening and follow-up of interstitial lung disease associated with rheumatoid arthritis (RA-ILD) is a challenge in clinical practice. In fact, the majority of RA-ILD patients are asymptomatic and optimal tools for early screening and regular follow-up are lacking. Furthermore, some patients may remain oligosymptomatic despite significant radiological abnormalities. In RA-ILD, usual interstitial pneumonia (UIP) is the most frequent radiological and pathological pattern, associated with a poor prognosis and a high risk to develop acute exacerbations and infections. If RA-ILD can be identified early, there may be an opportunity for an early treatment and close follow-up that might delay ILD progression and improve the long-term outcome.In connective tissue disease–associated interstitial lung disease (CTD-ILD), lung ultrasound (LUS) with the assessment of B-lines and serum Krebs von den Lungen-6 antigen (KL-6) has been recognized as sensitive biomarkers for the early detection of ILD. B-line number and serum KL-6 level were found to correlate with high-resolution computed tomography (HRCT), pulmonary function tests (PFTs), and other clinical parameters in systemic sclerosis–associated ILD (SSc-ILD). Recently, the significant correlation between B-lines and KL-6, two non-ionizing and non-invasive biomarkers, was demonstrated. Hence, the combined use of LUS and KL-6 to screen and follow up ILD in RA patients might be useful in clinical practice in addition to existing tools. Herein, we review relevant literature to support this concept, propose a preliminary screening algorithm, and present 2 cases where the algorithm was used.

【 授权许可】

CC BY