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AB1113 RELATION BETWEEN RESTRICTIVE PULMONARY FUNCTION TESTS AND ULTRASONOGRAPHIC CHANGES OF ASYMPTOMATIC ANTERIOR CHEST WALL JOINTS IN RHEUMATOID ARTHRITISPATIENTS

Background Ultrasonography can detect different changes in anterior chest wall (ACW) joints in patients with Rheumatoid Arthritis (RA) even before being clinically manifested.(1) Pulmonary functions may be affected during the course of RA due to interstitial lung problem or chest wall problem.(2) All studies usually demonstrate the interstitial pulmonary affection in RA but the chest wall joints is usually underestimated by the rheumatology community. Up to the best of our knowledge, there are no previous studies about the relationship between ultrasound detected subclinical changes in ACW and the pulmonary functions in RA patients. Objectives To detect the relation between ultrasonographic changes of asymptomatic ACW joints and pulmonary function tests (PFTs) in patients with RA. Methods The study included 44 subjects (22 RA and 22 control) in whom 88 sternoclavicular joints (SCJ) and 44 manibrusternal joints (MSJ) were studied. None of the participants had a history of respiratory complaints such as dyspnea, chronic cough, or chest pain. High resolution Computed Tomography (HRCT) was done on the chest to exclude interstitial lung problem that may affect chest expansion and PFTs. Ultrasound (US) assessments were performed to detect synovitis, erosions, ankylosis, osteophytes, or Doppler signals. Chest expansion was measured. PFTs was done and included measurement of the forced expiratory volume in1 s (FEV1), forced vital capacity (FVC), and the ratio of forced expiratory volume in 1 s to the forced vital capacity(FEV1/FVC). In RA group, DAS28 and Health Assessment Questionnaire Disability Index (HAQDI) were recorded. Results US detected subclinical changes of ACW joints in (74.2%) of RA patient with significant difference between total US changes in RA(74.2%) and control (21.2%) (p<0.001). MSJ ankylosing and erosions were highly associated with limited chest expansion in RA group(P <0.001). PFTs were found to be restrictive in 13 RA patient (59.1%) with mean of FVC (65.5±5)%, FEV1 (70.4± 9.1)%, FEV1/FVC (80.1 ±2.6) with significant difference to control with mean of FVC (93.6±7.2)%, FEV1 (94.3± 4.5)%, FEV1/FVC (95.1 ±2.4). These restrictive PFTs were associated with SCJ synovitis (p=0.04),SCJ PD activity (p =0.04), SCJ erosions (0.02) and highly associated with MSJ ankylosing and erosions (p< 0.001). All RA patients (100%) with MS ankylosing and erosions and SCJ PD activity by US had limited chest expansion and restrictive PFTs. Restrictive PFTs were associated also with limited chest expansion with mean of (2.3±0.5) with significant difference (p< 0.001) to non-restrictive PFTs in RA with mean of (5.2± 1.4). In RA group, ultrasonographic changes and restrictive PFTs were found to be higher with smoking, longer disease duration and high DAS28. Conclusion Our study demonstrated that ultrasonographic subclinical changes in ACW joints is associated with restrictive pattern of PFTs and limited chest expansion in RA patients. References [1] -Abdelrahman F, Mortada M, Abdul_Sattar A, et al; Annals of the Rheumatic Diseases 2017;76:733. [2] - Kalyani Praba P, Thamarai Selvi K, Vijay Anand B, Saravanan A. Evaluation of lung function tests in rheumatoid arthritis patients. Natl J Physiol Pharm Pharmacol 2017;7(7):693-696. Disclosure of Interests None declared