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Serial scanning of the thorax with high-resolution CT is useful for monitoring the response of sclerodermal lung disease to therapy, the report shows in the November Chest.

The report focuses on 98 patients with sclerodermal-interstitial lung disease who had completed one year of treatment with either cyclophosphamide or placebo in the randomized Scleroderma Lung Study. Cyclophosphamide had produced significant improvements in pulmonary function and symptoms, according to senior author Dr. Donald P. Tashkin, from the University of California, Los Angeles, and colleagues.

In the current analysis, Dr. Tashkin and colleagues compared parenchymal abnormalities between baseline and follow-up High-resolution CT scans.

Among the 49 patients in the cyclophosphamide arm, 14 had worse fibrosis scores at 12 months and 35 had scores that were not worse. In contrast, among the 49 patients in the placebo group, 26 had worse fibrosis scores at 12 months and 23 had scores that were not worse.

Treatment had no apparent effect on ground-glass opacity or honeycomb cyst appearance on high-resolution CT (HRCT). Furthermore, the baseline extent of ground-glass opacity did not have any significant effect on fibrosis outcome.

High-resolution CT fibrosis scores correlated with pulmonary function and skin thickness scores, the investigators say, and changes in dyspnea over time showed moderate correlations with changes in fibrosis.

"Our findings provide a rationale for performing follow-up High-resolution CT scans in patients with scleroderma interstitial lung disease undergoing treatment with oral cyclophosphamide or some other potentially active agent as a means of assessing the patient's response to therapy and determining whether additional treatment is needed in patients with HRCT evidence of progressive fibrosis despite their existing therapy," Dr. Tashkin told Reuters Health.

"High-resolution CT (HRCT) scans provide an objective method of assessing changes in both inflammation and fibrosis in the lungs of patients with interstitial lung disease," he added. "They therefore provide a useful complement to measured changes in lung physiology."

Source: Reuters

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