Underdetection of Interstitial Lung Disease in Juvenile Systemic Sclerosis

Ivan Foeldvari*, Jens Klotsche, Bernd Hinrichs, Nicola Helmus, Ozgur Kasapcopur, Amra Adrovic, Flavio Sztajnbok, Maria Teresa Terreri, Jordi Anton, Vanessa Smith, Maria Katsicas, Mikhail Kostik, Natalia Vasquez-Canizares, Tadej Avcin, Brian Feldman, Mahesh Janarthanan, Maria Jose Santos, Sujata Sawhney, Dieneke Schonenberg-Meinema, Walter Alberto Sifuentes-GiraldoEkaterina Alexeeva, Simone Appenzeller, Cristina Battagliotti, Lillemor Berntson, Blanca Bica, Patrícia Costa-Reis, Despina Eleftheriou, Tilmann Kallinich, Thomas Lehman, Edoardo Marrani, Kirsten Minden, Susan Nielsen, Farzana Nuruzzaman, Anjali Patwardhan, Raju Khubchandani, Valda Stanevicha, Yosef Uziel, Kathryn S. Torok*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Utilizing data obtained from a prospective, international, juvenile systemic sclerosis (SSc) cohort, the present study was undertaken to determine if pulmonary screening with forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLco) is sufficient to assess the presence of interstitial lung disease (ILD) in comparison to high-resolution computed tomography (HRCT) in juvenile SSc. Methods: The juvenile SSc cohort database was queried for patients enrolled from January 2008 to January 2020 with recorded pulmonary function tests (PFTs) parameters and HRCT to determine the discriminatory properties of PFT parameters, FVC, and DLco in detecting ILD. Results: Eighty-six juvenile SSc patients had both computed tomography imaging and FVC values for direct comparison. Using findings on HRCT as the standard measure of ILD presence, the sensitivity of FVC in detecting ILD in juvenile SSc was only 40%, the specificity was 77%, and area under the curve (AUC) was 0.58. Fifty-eight juvenile SSc patients had both CT imaging and DLco values for comparison. The sensitivity of DLco in detecting ILD was 76%, the specificity was 70%, and AUC was 0.73. Conclusion: The performance of PFTs in juvenile SSc to detect underlying ILD was quite limited. Specifically, the FVC, which is one of the main clinical parameters in adult SSc to detect and monitor ILD, would miss ~60% of children who had ILD changes on their accompanying HRCT. The DLco was more sensitive in detecting potential abnormalities on HRCT, but with less specificity than the FVC. These results support the use of HRCT in tandem with PFTs for the screening of ILD in juvenile SSc.

Original languageEnglish
Pages (from-to)364-370
Number of pages7
JournalArthritis Care and Research
Volume74
Issue number3
DOIs
StatePublished - Mar 2022

Funding

FundersFunder number
Joachim Herz Stiftung

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