Preclinical detection of pulmonary involvement: relationshipwith clinical features in scleroderma patients

Background Poor prognosis of systemic sclerosis-interstitial lung disease (SSc-ILD) emphasizes the importance of its early detection at an asymptomatic stage. Early treatment of ILD may achieve a better prognosis. Objective The aim of this study was the early detection of pulmonary involvement in SSc at an asymptomatic stage. Patients and methods Thirty SSc patients were recruited and classified as having diffuse or limited SSc. Patients with respiratory symptoms were excluded. Clinical examination, pulmonary function tests, high-resolution chest computed tomography (HR-CT), and serum transforming growth factor-β1 assessment were performed. The severity of skin thickness was evaluated on the basis of the modified Rodnan skin score, and the severity of Raynaud’s phenomenon was assessed using the visual analog scale, on the basis of the Medsger score. Results Seventeen patients (56%) had limited cutaneous SSc and 13 (44%) had diffuse cutaneous SSc. HR-CT showed ground glass opacities in 26% of patients. A decrease in diffusing lung capacity for carbon monoxide (DLCO) and forced vital capacity less than 80% were found in 30 and 43% of patients, respectively, more in the diffuse cutaneous SSc type. The visual analog scale score for Raynaud’s phenomenon was higher among patients with subclinical ILD. The extent of cutaneous involvement proved to be an independent risk factor for subclinical detection of SSc-ILD in both HR-CT and DLCO analyses, whereas the serum transforming growth factor-β1 level was unable to predict preclinical SSc-ILD. Conclusion Diffuse presentation of scleroderma and severe Raynaud’s phenomenon may be predictors for pulmonary involvement, detected in terms of HR-CT abnormalities and DLCO.