Pleuropulmonary involvement in patients with systemic lupus erythematosus from a Latin American inception cohort (GLADEL)

Abstract

Objectives The objectives of this study were to examine the demographic and clinical features associated with the occurrence of pleuropulmonary manifestations, the predictive factors of their occurrence and their impact on mortality in systemic lupus erythematosus (SLE) patients. Materials and methods The association of pleuropulmonary manifestations with demographic and clinical features, the predictive factors of their occurrence and their impact on mortality were examined in GLADEL patients by appropriate univariable and multivariable analyses. Results At least one pleuropulmonary manifestation occurred in 421 of the 1480 SLE patients (28.4%), pleurisy being the most frequent (24.0%). Age at SLE onset ≥30 years (OR 1.42; 95% CI 1.10-1.83), the presence of lower respiratory tract infection (OR 3.19; 95% CI 2.05-4.96), non-ischemic heart disease (OR 3.17; 95% CI 2.41-4.18), ischemic heart disease (OR 3.39; 95% CI 2.08-5.54), systemic (OR 2.00; 95% CI 1.37-2.91), ocular (OR 1.58; 95% CI 1.16-2.14) and renal manifestations (OR 1.44; 95% CI 1.09-1.83) were associated with pleuropulmonary manifestations, whereas cutaneous manifestations were negatively associated (OR 0.47; 95% CI 0.29-0.76). Non-ischemic heart disease (HR 2.24; 95% CI 1.63-3.09), SDI scores ≥1 (OR 1.54; 95% CI 1.10-2.17) and anti-La antibody positivity (OR 2.51; 95% CI 1.39-4.57) independently predicted their subsequent occurrence. Cutaneous manifestations were protective of the subsequent occurrence of pleuropulmonary manifestations (HR 0.62; 95% CI 0.43-0.90). Pleuropulmonary manifestations independently contributed a decreased survival (HR: 2.79 95% CI 1.80-4.31). Conclusion Pleuropulmonary manifestations are frequent in SLE, particularly pleuritis. Older age, respiratory tract infection, cardiac, systemic and renal involvement were associated with them, whereas cutaneous manifestations were negatively associated. Cardiac compromise, SDI scores ≥1 and anti-La positivity at disease onset were predictive of their subsequent occurrence, whereas cutaneous manifestations were protective. They independently contributed to a decreased survival in these patients.

Primary respiratory disease in patients with systemic lupus erythematosus: data from the Spanish rheumatology society lupus registry (RELESSER) cohort

“…Of the lung parenchymal manifestations, the most commonly observed was pneumonitis (3.6%). This is consistent with observations from other registries in which it was also the most frequent parenchymal complication; the reported prevalence was between 2.4% and 4% [2, 24].…”

“…According to the data from our registry, the overall prevalence of symptomatic pleuropulmonary manifestations in this SLE population was 31%, and pleural involvement was the most frequent complication. This prevalence is higher than that reported in the Eurolupus project (7%) [23] and is similar to that reported in the Latin American SLE cohort (Grupo Latinoamericano de Estudio del Lupus, or GLADEL), which recently examined this specific clinical aspect (28%) [2]. Prevalence rates from these three multicenter registries demonstrate that primary respiratory disease occurs in about 25–30% of patients with lupus during the course of the disease.…”

“…In most patients, pleuropulmonary involvement occurs in the setting of previous or concomitant involvement of other major organs. Apart from the frequent presence of systemic, cutaneous, and musculoskeletal symptoms, a considerable proportion of these patients have or have had nephritis (39% in our series and 40% of cases in the GLADEL registry), neuropsychiatric involvement (11% and 14%, respectively), and non-ischemic heart disease (16% and 14%, respectively) [2]. According to our study, the history of pericarditis, vasculitis, and gastrointestinal involvement is also frequent in this group of patients.…”

Epidemiology and management practices for childhood-onset systemic lupus erythematosus patients: a survey in Latin America

“…LA includes 33 countries and dependencies, a large population, two main languages (Spanish and Portuguese), with distinct socio-economic and political status. Two groups have reported data focused on epidemiology, clinical and laboratorial features of cSLE patients in LA: BRAC-SLE (Brazilian Childhood-onset SLE Registry Group) [2][3][4][5][6][7][8][9][10][11][12][13][14][15] and GLADEL (Grupo Latino Americano De Estudio del Lupus) [16][17][18][19].…”

Thank God for Lab: Systemic Lupus Erythematosus - A Difficult Diagnosis, a Difficult Disease

“…Pulmonary manifestations in SLE include pulmonary hypertension (found by cardiac ultrasound performed in our patient), lupus pneumonitis (revealed by thoracic CT). Other pulmonary manifestations can be: chronic lupus interstitial lung disease, complementmediated pulmonary leukoaggregation, alveolar hemorrhage, or infection (16). Our patient did not have the typical aspect of lupus pleurisy: exudative, with an elevated pleural lactate dehydrogenase level, but a transudate with normal LDH level.…”