Stefan Markus Walbom Harders

Objectives: Interstitial lung diseases (ILDs) are frequent and clinically important in SLE but diagnosis of ILD can be challenging. Thoracic ultrasound (TUS) shows promise in detecting ILD, hence, we aimed to evaluate the utility of TUS to identify ILD in SLE. Methods: Patients fulfilling the EULAR/ACR 2019 SLE classification criteria were invited. Participants were assessed for ILD by means of chest high-resolution computed tomography scans and pulmonary function tests and diagnosed at a multidisciplinary discussion, according to reference standards, independent of TUS. TUS evaluated the presence of B-lines and pleural abnormalities, blinded to status of ILD. The ability of B-lines to identify ILD using a prespecified threshold of ≥10 B-lines was analysed using diagnostic test accuracy measures. Further, we explored the diagnostic performance of B-lines and pleural abnormalities to identify ILD across various scenarios. Results: Among 185 patients with SLE, ILD were present in 22 (12%). With the predefined threshold of ≥10 B-lines, we found a modest diagnostic test accuracy as 14 of 22 ILD cases were classified as abnormal TUS, with diagnostic odds ratio of 10.7 (3.2–32.3), sensitivity of 64% (41–83%) and negative predictive value 97% (90–98%). In exploratory analyses, excluding participants with certain characteristics possibly affecting the TUS from the analyses improved the performance of TUS and pleural abnormalities were associated with ILD. Conclusion: In SLE, TUS focusing on the presence of B-lines demonstrated modest but statistically significant diagnostic test accuracy for detecting ILD. Pleural abnormalities were significantly associated to ILD.

Background/Objectives: Fibrosing interstitial lung disease (F-ILD) is associated with progressive respiratory impairment and substantial symptom burden. Diaphragmatic ultrasound (DUS) is a non-invasive method for assessing diaphragmatic structure and function, but its clinical role in F-ILD remains uncertain. This systematic review evaluated the available evidence on DUS in adults with F-ILD. Methods: This systematic review was conducted and reported according to the PRISMA guidelines. MEDLINE, Embase, CINAHL, and the Cochrane Library were searched and observational studies evaluating DUS in adults with F-ILD were included. Risk of bias was assessed using the QUADAS-2, and outcome-level certainty of evidence was evaluated by GRADE framework. Results: Six cross-sectional observational studies involving 232 participants were included. Diaphragmatic excursion (DE) was assessed in all six studies, while diaphragm thickness (DT) and thickening fraction (TF) were evaluated in four. Some studies reported abnormalities in DUS parameters during deep breathing and cross-sectional associations with pulmonary function, exercise capacity, dyspnoea, or radiological severity. Substantial heterogeneity in study populations, ultrasound protocols, and outcome reporting precluded meta-analysis. The certainty of evidence was very low. Conclusions: Current evidence suggests that DUS may detect diaphragmatic abnormalities in patients with F-ILD and may have future complementary value alongside established clinical assessments. However, the evidence is limited, heterogeneous, and of very low certainty and does not establish diagnostic accuracy, prognostic value, or usefulness for longitudinal monitoring. Accordingly, DUS cannot currently be recommended for routine clinical implementation in F-ILD, and prospective longitudinal validation is required.

Pneumocystis pneumonia (PCP) is a serious fungal infection in immunocompromised patients. We investigated the prevalence of Pneumocystis jirovecii (PJ) colonization using oral wash polymerase chain reaction (PCR) in Danish rheumatoid arthritis (RA) patients with respiratory symptoms or recurrent pneumonia, and assessed its diagnostic utility for PCP. This secondary analysis of the AURORA study included 76 consenting adults (aged ≥ 18 years) with RA and respiratory symptoms or recurrent pneumonia. Oral wash samples were tested for PJ using a validated PCR assay. All patients underwent pulmonary assessment, including high-resolution computed tomography (HRCT). Medical records were audited for PCP diagnoses after 2 years. The mean age was 65.6 years, 63% were female, 24% received biological disease-modifying anti-rheumatic drug treatment, and 8% had received biological treatment of >3 years' duration. Only one patient (1%), treated with methotrexate and rituximab and presenting with recurrent pneumonia, cough, and dyspnoea, tested positive for PJ. HRCT showed pneumonia, interstitial lung disease (usual interstitial pneumonia pattern), bronchiectasis, and emphysema. PCP was confirmed by a respiratory physician based on clinical presentation. No other patients developed PCP during follow-up. Oral colonization with PJ was rare in this cohort of Danish RA patients with respiratory symptoms. The low prevalence of colonization and the absence of PCP in PJ-negative patients suggest that routine screening for oral PJ colonization is not warranted in this population.

Introduction Fibrosing interstitial lung disease (F-ILD) are a heterogeneous group of diseases with multiple subtypes. Both idiopathic pulmonary fibrosis and other ILDs associated with a risk of developing progressive pulmonary fibrosis (PPF) are subtypes of this category. A multidisciplinary team discussion, including a chest high-resolution CT (HRCT), is usually considered the gold standard for diagnosis of F-ILD. Repeated HRCT is one of several established methods to assess progression and thus development of PPF, but it is associated with substantial costs and radiation exposure. Thoracic ultrasound (TUS) and other ultrasound (US) methods have emerged as radiation-free methods for both diagnosing and monitoring disease severity in F-ILD. Yet, consistent knowledge on the use of different TUS- and US methods in patients with F-ILD is limited. Methods The LORD study is a prospective cohort study conducted in participants with F-ILD at a tertiary ILD centre in Denmark. Physiological testing and patient-related outcome measures, together with TUS- and US examinations, will be performed at inclusion, after 6 and 12 months. The correlations between these assessments will be evaluated. HRCT will be conducted between 3 months prior to and 1 month after baseline, and after 1 year. At least 34 participants will be included. Ethics and dissemination The protocol was approved by the Danish Data Protection Agency (journal number: 22/45135) and the Science Ethics Committee for the Region of Southern Denmark (journal number: S-20220036). Results will be published in peer-reviewed international journals and will be presented at an international congress. Trial registration number NCT06844331.

Background and Objectives: Pulmonary diseases (PD) are common in Systemic Lupus Erythematosus (SLE) and associated with increased mortality and decreased health-related quality of life, but no study has so far addressed PD in newly diagnosed patients with SLE. Our objectives were among newly diagnosed patients with SLE to investigate: Primarily, if PD and subtypes of PD are present, and secondarily characterise the patients by means of (i) lung physiology, (ii) radiology, (iii) thoracic ultrasound (TUS) and diaphragmatic ultrasound (DUS). Methods: Patients newly diagnosed with SLE from 1st July 2023 to 31st July 2024 at Odense University Hospital, Odense, Denmark, underwent a dedicated clinical evaluation for PD, including pulmonary function tests (PFT), chest high-resolution computed tomography or computed tomography scan alongside with TUS and DUS. Subsequently, PD were diagnosed, and subtype was categorised on a multidisciplinary discussion. Results: Ten participants were included in average 3 months after SLE diagnosis, and six out of ten had PD. PD included one case of shrinking lung syndrome (SLS) and two cases of interstitial lung disease. All participants exhibited at least one abnormal PFT measure, with some showing severely reduced pulmonary function. TUS was associated with diseases of the lung parenchyma and pleura and DUS with SLS. Conclusion: We found PD among newly diagnosed patients with SLE and in some cases associated with severely affected pulmonary function. TUS and DUS may contribute with information in diagnosing SLE related PD, but further studies are needed.

Pulmonary disease is a major cause of excess mortality among patients with rheumatoid arthritis (RA). Interstitial lung disease (ILD) is a feared complication, but the benefit of screening is unkno...

Introduction Pulmonary diseases are significant contributors to morbidity and mortality in patients with rheumatoid arthritis (RA). RA-associated interstitial lung disease (RA-ILD) may be prevalent in up to 30% and clinically evident in 10% of patients with RA. Feasible methods to detect concomitant ILD in RA are warranted. Our objective is to determine the diagnostic accuracy of thoracic ultrasound (TUS) for ILD in patients with RA with respiratory symptoms, by using chest high-resolution CT (HRCT) as the reference standard. Further, we aim to evaluate the diagnostic accuracy for the promising blood biomarkers surfactant protein-D and microfibrillar-associated protein 4 in the detection of ILD in this group of patients. Methods and analysis By use of a standardised 14 zone protocol patients suspected of having RA-ILD will undergo TUS as index test performed by a junior resident in rheumatology (BKS), who is certified by the European Respiratory Society in performing TUS assessments. Participants form a consecutive series of up to 80 individuals in total. The anonymised TUS images will be stored and scored by the junior resident as well as two senior rheumatologists, who have received training in TUS, and a TUS-experienced pulmonologist. HRCT will be used as the gold standard for ILD diagnosis (reference standard). The two basic measures for quantifying the diagnostic test accuracy of the TUS test are the sensitivity and specificity in comparison to the HRCT. Ethics and dissemination Data will be collected and stored in the Research Electronic Data Capture database. The study is approved by the Committees on Health Research Ethics and the Danish Data Protection Agency. The project is registered at clinicaltrials.gov (NCT05396469, pre-results) and data will be published in peer-reviewed journals.

The objective of this feasibility study was to assess computed tomography (CT) texture analysis (CTTA) of pulmonary lesions as a predictor of overall survival in patients with suspected lung cancer on contrast-enhanced computed tomography (CECT). In a retrospective pilot study, 94 patients (52 men and 42 women; mean age, 67.2 ± 10.8 yrs) from 1 center with non-small cell lung cancer (NSCLC) underwent CTTA on the primary lesion by 2 individual readers. Both simple and multivariate Cox regression analyses correlating textural parameters with overall survival were performed. Statistically significant parameters were selected, and optimal cutoff values were determined. Kaplan–Meier plots based on these results were produced. Simple Cox regression analysis showed that normalized uniformity had a hazard ratio (HR) of 16.059 (3.861–66.788, P < .001), and skewness had an HR of 1.914 (1.330–2.754, P < .001). The optimal cutoff values for both parameters were 0.8602 and 0.1554, respectively. Normalized uniformity, clinical stage, and skewness were found to be prognostic factors for overall survival in multivariate analysis. Tumor heterogeneity, assessed by normalized uniformity and skewness on CECT may be a prognostic factor for overall survival.