Diagnostic accuracy of a velcro sound detector (VECTOR) for interstitial lung disease in rheumatoid arthritis patients: the InSPIRAtE validation study (INterStitial pneumonia in rheumatoid ArThritis with an electronic device)

Abstract

Background Interstitial lung disease (ILD) is a severe systemic manifestation of rheumatoid arthritis (RA). High-resolution computed tomography (HRCT) represents the gold standard for the diagnosis of ILD, but its routine use for screening programs is not advisable because of both high cost and X-ray exposure. Velcro crackles at lung auscultation occur very early in the course of interstitial pneumonia, and their detection is an indication for HRCT. Recently, we developed an algorithm (VECTOR) to detect the presence of Velcro crackles in pulmonary sounds and showed good results in a small sample of RA patients. The aim of the present investigation was to validate the diagnostic accuracy of VECTOR in a larger population of RA patients, compared with that of the reference standard of HRCT, from a multicentre study. Methods To avoid X-ray exposure, we enrolled 137 consecutive RA patients who had recently undergone HRCT. Lung sounds of all patients were recorded in 4 pulmonary fields bilaterally with a commercial electronic stethoscope (ES); subsequently, all HRCT images were blindly evaluated by a radiologist, and audio data were analysed by means of VECTOR. Results Fifty-nine of 137 patients showed ILD (43.1%). VECTOR correctly classified 115/137 patients, showing a diagnostic accuracy of 83.9% and a sensitivity and specificity of 93.2 and 76.9%, respectively. Conclusions VECTOR may represent the first validated tool for the screening of RA patients who are suspected for ILD and who should be directed to HRCT for the diagnosis. Moreover, early identification of RA-ILD could contribute to the design of prospective studies aimed at elucidating unclear aspects of the disease.

Safety of Abatacept in Italian Patients with Rheumatoid Arthritis and Interstitial Lung Disease: A Multicenter Retrospective Study

“…Finally, an early diagnosis of ILD in RA patients should be encouraged to increase our knowledge of the natural history of ILD, its possible predictive factors, and the possible involvement of DMARDs in the development and progression of this RA complication [40].…”

Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease: Lights and Shadows

“…Indeed, an early diagnosis is needful to ensure that each patient receives appropriate treatment for their particular clinical phenotype and to avoid the use of drugs potentially involved in ILD worsening. In this regard, we recently proposed the use of VECTOR as a simple, non-invasive and inexpensive tool for the screening of RA patients suspected for ILD [223].…”

Combination Therapy with Nintedanib and Sarilumab for the Management of Rheumatoid Arthritis Related Interstitial Lung Disease

“…Treatment, mainly based on corticosteroids and immunosuppressants [4], is not well defined and efficacy data are not still available. On the other hand, the supposed role of many conventional and biologic disease-modifying antirheumatic drugs (DMARDs) in the onset or worsening of preexisting ILD in RA further complicates the therapeutic choice for these patients [3,9,10].…”

“…Interstitial lung disease (ILD) is the most common lung involvement, with an estimated prevalence ranging from 4 to 30%, and significantly affects the therapeutic approach, quality of life, morbidity, and mortality of RA patients [2,3]. e treatment of RA-ILD is still debated, and it is mainly based on corticosteroids and immunosuppressants [4].…”