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A 42-year-old female patient is recently diagnosed with diffuse cutaneous systemic sclerosis (anti-Scl-70 positive). She does not have any respiratory symptoms. The lung function test shows no sign of restriction (FVC 91%; FEV1 83%; FEV1%/FVC 91%; TLC 99%).

Your Answer is Incorrect

Answer with Detailed explanation

The correct answer is Chest CT

Systemic sclerosis-associated interstitial lung disease (SSc-ILD) is diagnosed in about 50% of patients diagnosed with SSc and is associated with a high mortality rate. As a substantial number of patients with SSc-ILD are asymptomatic, screening for SSc-ILD is of paramount importance. As the sensitivity and diagnostic accuracy of chest radiographs in SSc-ILD are very low, they are not indicated for ILD screening.

Lung function test is an important tool in the initial assessment and follow-up of patients with SSc-ILD. However, as the lung function test's false-negative rate is substantial, it cannot rule out SSc-ILD. Consequently, a current evidence-based European consensus statement suggests performing a screening HRCT in all patients with SSc-ILD at baseline.

Reference:

• Hoffmann-Vold AM, et al. Arthritis Rheumatol. 2015;67(8):2205-12.
• Sulimann YA et al. Arthritis Rheumatol. 2015;67(12):3256-61.
• Hoffmann-Vold AM et al. Lancet Rheumatology. 2020;2:e71-e83.

By Prof Helmut Prosch, Associate Professor of Radiology, University of Vienna, Austria

Your Answer is Correct

Answer with Detailed explanation

Systemic sclerosis-associated interstitial lung disease (SSc-ILD) is diagnosed in about 50% of patients diagnosed with SSc and is associated with a high mortality rate. As a substantial number of patients with SSc-ILD are asymptomatic, screening for SSc-ILD is of paramount importance. As the sensitivity and diagnostic accuracy of chest radiographs in SSc-ILD are very low, they are not indicated for ILD screening.

Lung function test is an important tool in the initial assessment and follow-up of patients with SSc-ILD. However, as the lung function test's false-negative rate is substantial, it cannot rule out SSc-ILD. Consequently, a current evidence-based European consensus statement suggests performing a screening HRCT in all patients with SSc-ILD at baseline.

Reference:

• Hoffmann-Vold AM, et al. Arthritis Rheumatol. 2015;67(8):2205-12.
• Sulimann YA et al. Arthritis Rheumatol. 2015;67(12):3256-61.
• Hoffmann-Vold AM et al. Lancet Rheumatology. 2020;2:e71-e83.

By Prof Helmut Prosch, Associate Professor of Radiology, University of Vienna, Austria