Quantification of Ground Glass Opacities Can Be Useful to Describe Disease Activity in Systemic Sclerosis

Abstract

Interstitial lung disease (ILD) is the main cause of death in systemic sclerosis (SSc) patients. Usually, patients have lung involvement characterized by ground glass opacities (GGOs), but honeycombing (HC) is also possible. The Wells score is a semi-quantitative index, which is able to assess ILD by distinguishing its main components. The aim of this work is to evaluate the Wells score in relation to the disease activity (DA) index. We enrolled 40 consecutive SSc-ILD patients (26 diffuse cutaneous form, dcSSc, and 14 limited form, lcSSc). All patients were evaluated by the European Scleroderma Study Group (ESSG) index, high-resolution computed tomography, transthoracic echocardiogram, pulmonary function tests (PTSs), and nailfold videocapillaroscopy for the number of microhemorrhages (NEMO) score. In our study, the total extent of ILD (TE-ILD), fibrosis and GGOs correlated with dyspnea (p = 0.03, 0.01 and 0.01 respectively), but not with the ESSG index. Considering only the dcSSc patients, TE-ILD and GGOs correlated with the ESSG index (r = 0.5 p = 0.009), while fibrosis grade correlated with disease duration and systolic pulmonary artery pressure. In conclusion, our data suggest that GGO correlates with DA, while fibrosis may be a sign of disease damage. The quantification of pulmonary involvement using the Wells score can be a useful tool for assessing the appropriate treatment in SSc patients.

Lung Abnormalities in Systemic Sclerosis Patients through Spirometry, Chest X-Ray, and High-Resolution Computed Tomography Scan

“…When a chest HRCT scan is performed on a subject who has a chest X-ray in the form of active TB, there is no visible On the chest HRCT scan, the most common type of lung lesion in SSc patients with pulmonary abnormalities was the type of GGO lesion, which were 46 subjects (82%). This is consistent with the study conducted by Sambataro et al 21 in 2020, which states that the type of GGO lesions often appears on the chest HRCT scan of SSc patients with pulmonary abnormalities.…”

Quantitative chest tomography indexes are related to disease activity in systemic sclerosis: results from a cross-sectional study

“…The data observed by HRCT clearly provides direct evidence of lung involvement. In a previous study, a correlation was observed between ground glass opacities measured by semiquantitative methods and DA in the diffuse cutaneous variant of SSc, but the method is bound to variability among observers (11). The correlation between QCT indexes and DA supports the possibility to overcome this limitation.…”

“…Several attempts have recently been made to standardise CT evaluation. Semi-quantitative scores have a good correlation with DA (11). These scores are burdened by relevant variability, even among expert observers (12)(13).…”

Nailfold Videocapillaroscopy Is a Useful Tool to Recognize Definite Forms of Systemic Sclerosis and Idiopathic Inflammatory Myositis in Interstitial Lung Disease Patients

“…Actually, none of these factors have been proven to influence significantly NVC [23][24][25]. Conflicting results are also reported regarding the association between PFTs and NVC in SSc, no association was reported in IPF and evidences in other ILDs are totally lacking [26][27][28][29].…”