Association of Interstitial Lung Disease With Clinical Characteristics of Chinese Patients With Systemic Lupus Erythematosus

Abstract

Objectives: This study aims to evaluate the frequency and clinical and laboratory features of interstitial lung disease (ILD) in Chinese patients with systemic lupus erythematosus (SLE) and to evaluate the association of ILD with the clinical features. Patients and methods: The study included 505 SLE patients (64 males, 441 females; mean age 35.3±15.3 years; range, 14 to 87 years) who were categorized into two groups as 449 patients without ILD and 56 patients with ILD based on evidence obtained from high-resolution computed tomography images. The demographic data, clinical and laboratory findings, SLE disease activity index score, and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index of all patients were also recorded and statistically analyzed. Results: The ILD frequency in patients with SLE was 11.1%. Compared to the group of SLE patients without ILD, the group of SLE patients with ILD possessed the following statistical differences: elderly age, longer illness duration, lower level of anti-double-stranded deoxyribonucleic acid, and higher level of serum complement 3, increased ratios of Raynaud's phenomenon, moist rales and tachypnea. Multivariate logistic regression results suggested that elderly age (≥60 years), long illness duration (1-10 years, ≥10 years), Raynaud's phenomenon, and tachypnea were statistically associated with the occurrence of ILD in SLE patients. Conclusion: Chinese SLE patients who possessed the factors that were statistically associated with ILD, namely, elderly age (≥60 years old), long illness duration (≥1 years), Raynaud's phenomenon, and tachypnea, were recommended to be monitored for the possibility of ILD.

Epidemiology of interstitial lung disease in systemic lupus erythematosus in France: A nation‐wide population‐based study over 10 years

“…On the other hand, a previous necropsy study identified pulmonary fibrosis in only four lung specimen from 120 SLE patients 5 . Consistent with the literature, ILD in SLE was related to age and other comorbid conditions 11,12 …”

“…5 Consistent with the literature, ILD in SLE was related to age and other comorbid conditions. 11,12 Indeed, almost a third of SLE patients with ILD had, in addition to SLE, another autoimmune disorder-such as Sjögren's syndrome, systemic sclerosis, mixed connective tissue disorder or inflammatory myopathy-which all are at specific risk for lung involvement. The frequency of ILD in SLE is thus exceedingly rare and a high proportion of SLE patients with ILD had an 'overlapping' SLE.…”

Sexual Dimorphism in Interstitial Lung Disease

“…People with SLE, a condition associated with a dramatic gender disparity in adults (9:1, female:male), have many reported pulmonary complications including pleural disease, ILD, vasculitis, pulmonary embolism, pulmonary hypertension, large airway disease, shrinking lung syndrome, and infection. Historically, the prevalence of SLE-associated ILD has been suggested to be very low, between 3 and 9% [ 76 , 77 ] although these figures predate high resolution CT. More recent estimates show the prevalence closer to 10% [ 78 ] with maintenance of the female predominance seen in adult SLE. Major risk factors for developing SLE-associated ILD include long disease duration, and in particular older age at onset.…”

Respiratory Manifestations in Systemic Lupus Erythematosus

“…Chronic interstitial lung disease (ILD) in SLE seems to be less frequent in comparison to other connective tissue diseases (CTDs), and it is rarely severe [ 10 , 48 , 49 , 50 ]. The exact prevalence is probably underestimated, because older studies performing chest X-ray have shown the presence of ILD in 6–24% of SLE patients, while in those using a more sensitive method such as HRCT, ILD was found in up to 70% of cases, suggesting that the condition is frequently subclinical [ 10 , 49 , 51 ].…”

“…The exact prevalence is probably underestimated, because older studies performing chest X-ray have shown the presence of ILD in 6–24% of SLE patients, while in those using a more sensitive method such as HRCT, ILD was found in up to 70% of cases, suggesting that the condition is frequently subclinical [ 10 , 49 , 51 ]. Risk factors for ILD include older age, late-onset SLE, illness duration (≥1 year), tachypnea, low levels of anti-dsDNA, high level of C3 and male gender [ 48 , 49 , 50 , 51 , 52 ]. The presence of Raynaud’s phenomenon, swollen fingers, sclerodactyly, telangiectasia, nailfold capillary abnormalities among SLE patients was associated with a higher prevalence of restrictive deficit and reduced DLCO, probably in the context of overlap syndromes that seem to carry a worse lung prognosis.…”