AB0663 PULMONARY INVOLVEMENT IN PATIENTS WITH SEROPOSITIVE AND ACPA POSITIVE RHEUMATOID ARTHRITIS (RA-ILD) – NOVEL SCREENING PROTOCOL FOR EARLY DETECTION OF PULMONARY INVOLVEMENT

Background:

Seropositive and ACPA positive Rheumatoid Arthritis (RA) is correlated with notable cardiovascular and pulmonary comorbidity^{1, 2}.

Objectives:

Nevertheless, there is currently no established screening method for early detection of pulmonary involvement, particularly interstitial lung disease (ILD) in patients with seropositive and ACPA positive Rheumatoid Arthritis.

Methods:

In the context of this study we included in a first step an amount of 50 consecutive patients with a confirmed diagnosis of seropositive and ACPA positive Rheumatoid Arthritis without symptoms for or known cardiopulmonary disease. To screen for pulmonary, pleural or vascular manifestation of the disease we applied a noninvasive radiation-free method by means of pulmonary function tests (PFT), cardiopulmonary exercise test (CPET), echocardiography and pleuro-pulmonary transthoracic ultrasound (LUS).

Results:

For this analysis the data from 43 patients (mean age 58.5 years, 81.4% female, 93.02% non-smokers) were available, while we are still in the process of collecting data as part of the study's second step. With an average disease duration of 10.1 years and with a mean remission of DAS28 ESR 2.3, DAS28 CRP 2.2 or low disease activity (CDAI 6.2, SDAI 6.6), respectively, depending on the used disease activity score, 34.88 % showed an erosive course. In 3 patients we demonstrated a reduced forced vital capacity (FVC ≤80%) on PFT (6.98%), a reduced CO-diffusion capacity (DLCOc-SB ≤80%) in 14 patients (32.56%). Noticeable changes in LUS were detected in 39% of patients, 23% with a pattern compatible with ILD. ILD was suspected in 13% showing indications on LUS along with additional changes in PFT. Numerous other RA- and ILD-associated parameters were collected in the present study (Tables 1 and 2). Other findings included pleural consolidation suspicious for malignancy and pleural effusion on ultrasound, severe aortic stenosis in bicuspid aortic valve, severe impaired diffusion capacity due to lung emphysema and obstructive lung disease on pulmonary function tests. None of the patients showed signs of pulmonary vascular involvement or cardiac ischaemia on echocardiography or CPET.

Conclusion:

In conclusion screening of RA-patients for pulmonary involvement may reveal a considerable number of asymptomatic patients with signs consistent with pulmonary manifestation of rheumatoid arthritis, along with a variety of other cardiopulmonary comorbidities. For deeper validation of the presented results we continue to collect data in a second step of this study including additional 150 patients.

REFERENCES:

[1] Drosos GC, Vedder D, Houben E, et al. EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome. Annals of the Rheumatic Diseases 2022; 81: 768 – 779. [2] Kadura S, Raghu G. Rheumatoid arthritis-interstitial lung disease: manifestations and current concepts in pathogenesis and management. Eur Respir Rev 2021; 30: 210011 [DOI: 10.1183/16000617.0011-2021]. Table 1. (descriptive characteristics, total sample, n = 43) Table 2.

Acknowledgements:

Acknowledgement text on presentation: This is an independent, investigator-initiated study supported by Boehringer Ingelheim, Germany. Boehringer Ingelheim has no role in the design, analysis or interpretation of the results in this study; Boehringer Ingelheim was given the opportunity to review the manuscript for medical and scientific accuracy as it relates to Boehringer Ingelheim substances, as well as intellectual property considerations.

Disclosure of Interests:

Martin Welcker Abbvie, Alexion, Aescu, Amgen, Biogen, BMS, Boehringer, Celltrion, Fresenius, Galapagos, Gilead, GSK, Hexal, Janssen, Medac, MSD, Mundipharma, Mylan, Novartis, Pfizer, Riemser, Roche, Sanofi-Aventis, SOBI, UCB, Abbvie, Alexion, Aescu, Amgen, Biogen, BMS, Boehringer, Celltrion, Fresenius, Galapagos, Gilead, GSK, Hexal, Janssen, Medac, MSD, Mundipharma, Mylan, Novartis, Pfizer, Riemser, Roche, Sanofi-Aventis, SOBI, UCB, Boehringer Ingelheim, Frank Reichenberger Boehringer Ingelheim, GSK, Roche, Boehringer Ingelheim, GSK, Roche, Boehringer Ingelheim, Carina Fischinger: None declared, Martin Hoffmann: None declared, Nikolaus Kneidinger: None declared, Florian Popp Boehringer Ingelheim, Werner von Wulffen Boehringer Ingelheim.