Lung ultrasound as a screening tool for interstitial lung disease in patients with rheumatoid arthritis: state of the art.

Purpose of review: This review describes the properties and examines available evidence supporting LUS as a screening tool for interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA). ILD is a common and serious complication of RA, associated with high mortality rates, especially when diagnosed late. Despite its high prevalence and significant prognostic impact, the need for and approach to systematic screening for lung involvement in RA remain unclear and are not recommended in current guidelines. While high-resolution computed tomography (HRCT) is the gold standard for diagnosing ILD, it cannot be frequently repeated due to limitations in the availability, cost, and radiation exposure.

Recent findings: Lung ultrasound (LUS) has emerged as a potential noninvasive, accurate, low-cost, and nonionizing alternative for detecting ILD, offering high sensitivity and negative-predictive value (NPV) compared to HRCT. Key LUS findings indicative of ILD include B-line artefacts (BLA) and pleural irregularity. Evidence supporting the performance and applicability of LUS in diagnosing RA-ILD continues to grow.

Summary: LUS has shown a good performance in ILD detection. Further research and standardization efforts are needed to fully integrate LUS into routine RA screening protocols.