Ab0428 ultrasound assessed nail bed thickness as an early screening marker for interstitial lung disease in scleroderma

Background:Interstitial lung disease (ILD) is the most frequent pulmonary manifestation of scleroderma and is seen in 80% of the patients with diffuse and in 20% of the limited forms of scleroderma.1 Even seen in early stages of the disease with varying degrees of severity, it does not correlate with the clinical manifestations.2 Hence, it is difficult to select patients for ILD screening based on symptoms. Digital clubbing is a common feature of ILD and has been associated with poor prognosis.3Objectives:To assess the ultrasound measured nail bed thickness (NBT) in cases of scleroderma as a screening marker to detect ILD and its inter-digital variation.Methods:A prospective observational study involving 15 patients each of scleroderma with ILD, without ILD and controls visiting our clinic from August 2020 to December 2020 were included. The presence of ILD was confirmed by HRCT thorax. Patients with a history of smoking, alcohol intake or pre-existing cardio-respiratory illnesses were excluded. Ultrasound assessed NBT was calculated using Philips affiniti 70 eL18-4 probe. A total of 436 nail beds were recorded (142 of scleroderma with ILD, 144 of scleroderma without ILD and 150 of control group). 14 nails were excluded due to trauma. Statistical analysis was done using ANOVA test. Results were considered significant at p value < 0.05.Results:On comparing nail bed thickness among scleroderma with ILD, scleroderma without ILD and control groups, the difference in NBT was statistically significant in all the three groups, except for left 1st finger (Table 1). NBT’s among scleroderma patients without ILD and control group did not show significant difference between the two groups. Whereas, when scleroderma patients with ILD were compared with control group, statistical significance were found (p<0.001) in all the fingers of both the hands, except 1st and 2nd finger of left and right hand respectively. On comparing NBT’s among individual fingers of right hand in patients of scleroderma with ILD and without ILD, a statistically significant difference among the two groups in 2nd (p =0.002), 4th (p=0.009) and 5th finger (p=<0.001) was noted. In left hand, same fingers had statistically significant difference (p<0.001).Conclusion:Patients of scleroderma with ILD are predisposed for an increase in the NBT, which can be detected using ultrasound. Thus, an increased NBT may have a role in early screening for the detection of ILD in scleroderma patients. Further studies with large patient data should be done to look at ultrasound assessed NBT as it may be utilized as a marker for ILD in scleroderma, as a widely available and an inexpensive tool.References:[1]Boin F, Wigley FM. Clinical Features and Treatment of Scleroderma. In:Firestein G, Budd R, Sherine E, et al, eds. Kelley’s Textbook of Rheumatology. Philadelphia, PA: Elsevier; 2013:1366–1403.[2]Hassan RI, et al. Lung ultrasound as a screening method for interstitial lung disease in patients with systemic sclerosis. JCR: Journal of Clinical Rheumatology. 2019;25(7):304-7.[3]T.E. King Jr., J.A. Tooze, M.I. Schwarz, K.R. Brown, R.M. CherniackPredicting survival in idiopathic pulmonary fibrosis: scoring system and survival modelAm. J. Respir. Crit. Care Med., 164 (7) (2001), 1171-81.Table 1.Nail bed thickness in patients of scleroderma with ILD, without ILD and control groups.FingerScleroderma with ILDn=15Scleroderma without ILDn=15Controln=15p-valueMeanSDMeanSDMeanSDRight1st1.860.2391.710.0811.690.1070.0212nd1.730.3031.500.0791.610.1080.0033rd1.890.2001.750.0911.500.131<0.0014th1.800.2631.390.1471.350.078<0.0015th1.800.1191.240.0951.290.069<0.001Left1st1.980.4421.720.0841.680.0500.0782nd1.820.1231.570.1251.570.092<0.0013rd2.050.3091.760.0781.420.109<0.0014th1.920.2461.360.1301.350.107<0.0015th1.810.1581.150.3681.230.103<0.001Figure 1.NBT measurement of right 2nd finger in scleroderma patient with ILD on ultrasoundDisclosure of Interests:None declared