Use of Steroids in Symptomatic Relief in Hepatitis A Virus-induced Cholestasis: A Case Series 139 Sandeep Goyal, Manjri, Virender Katyal Necrotising Lymphadenitis in a Rare Overlap of SLE with Ankylosing Spondylitis

Background: Interstitial lung disease (ILD) and pulmonary artery hypertension account for 60% of systemic sclerosis (SSc) related deaths. Impaired gas exchange that worsens with exercise is central to the pathophysiology of SSc-related ILD (SSc-ILD). Six minute walk test (6MWT) is a simple and cost-effective tool to assess lung function and has been proven to be reproducible. It has the potential to be employed as a tool to assess and monitor severity of pulmonary involvement in SSc. Aims and objectives: This study evaluates the correlation between 6MWT results with the other parameters of disease severity like forced vital capacity (FVC), diffusion capacity of lung for carbon monoxide (DLCO) from pulmonary function tests, right ventricular systolic pressure (RVSP) by echocardiography, HRCT findings like pulmonary artery dilatation and honeycombing and clinical findings like modified Rodnan skin score (mRSS) in patients of SSc-ILD. Materials and methods: 30 patients with SSc-ILD were subjected to two 6MWTs. Six minute walk distance (6MWD) < 400 m and fall in saturation during 6MWT (Sat)  4% were considered abnormal. 6MWD of the two tests were compared. If the variability was more than 15%, a third test was planned. The two tests with 6MWD within 15% variability were considered for our studies. Then, 6MWD and Sat were compared with FVC, DLCO, RVSP, HRCT and clinical findings like mRSS. Results: There was no statistically significant correlation between 6MWD and Sat (p = 0.51). On univariate analysis, there was no statistically significant correlation of 6MWD < 400 m with mRSS(p = 0.07), %FVC (p = 0.59), %DLCO (p = 0.68), RVSP (p = 0.35) and pulmonary artery dilatation on HRCT (p = 0.713). There was statistically significant positive correlation between 6MWD < 400 m and pre-test Borg index (p = 0.04) and post-test Borg score (p = 0.02). On multi-variate logistic analysis, no parameters had statistically significant correlation with 6MWD < 400 m. However, on univariate analysis, there was statistically significant negative correlation of Sat  4% on 6MWT with % FVC (p = 0.04) and % FEV1 (p = 0.027) and statistically significant positive correlation pre-test Borg score (p = 0.02), post-test Borg dyspnoea score (p < 0.0001), honey combing on HRCT (p = 0.044) and pulmonary artery dilatation on HRCT (p = .01). There was no statistically significant correlation between Sat 4% and % DLCO (p = 0.24), RVSP (p = 0.74) or mRSS (p = 0.79). On multivariate logistic analysis, only pulmonary artery dilatation on HRCT had statistically significant positive correlation with Sat 4% (p = 0.04). Conclusions: 6MWT is a highly reproducible test. Desaturation during 6MWT is more reflective of pulmonary involvement and is an adjunct to pulmonary function tests in evaluation of patients with SSc-ILD. 6MWD is subjective and depends on patient motivation.