Pulmonary manifestations in systemic lupus erythematosus: Association with disease activity

Abstract

Background and objectiveAlthough systemic lupus erythematosus (SLE) is the most common connective tissue disease affecting the lung, few studies have assessed risk factors that predict pulmonary manifestations. The objectives of the present study were to determine the prevalence of lung manifestations in SLE patients from Western Saudi Arabia by analysing results from high-resolution computed tomography (HRCT) scans and to identify independent risk factors for lung involvement.MethodsThis was a 10-year retrospective study involving 184 SLE patients. We examined all HRCT lung abnormalities and determined whether findings were associated with the presence of lupus nephritis (LN), SLE disease activity (as defined by SLE Disease Activity Index 2000 item scores ≥4 for any and all items) or levels of complement and anti-double-stranded DNA (anti-dsDNA).ResultsWe identified 61 patients (33%) with pulmonary involvement, and 52 (85%) of these subjects showed HRCT abnormalities. The most common HRCT findings were pleural effusion, consolidation and atelectasis (58%, 42% and 42%, respectively). There was a significant association between abnormal HRCT results and hypocomplementemia, high levels of anti-dsDNA and disease activity (P < 0.05), particularly with regard to pleuropericardial effusion and consolidation. Pulmonary abnormalities were significantly higher within the first five years after SLE diagnosis (P < 0.001). However, neither disease duration nor LN was associated with increased risk.ConclusionsLung manifestations were frequent in SLE patients from Saudi Arabia, with pleural effusion, consolidation and atelectasis being the most common. Low complement levels, high anti-dsDNA levels and disease activity were significantly associated with abnormal HRCT findings (all P < 0.001).

Associates and predictors of pleurisy or pericarditis in SLE

“…14 Pleural effusion was shown to be associated with anti-DNA in one previous study from Saudi Arabia of 61 patients. 23 Low complement (C3 and C4) was associated with both pericarditis and pleurisy in our univariate cross-sectional and prospective analyses. Other investigators 24 observed a relatively weak association of pericardial tamponade with low C4 (p=0.05), compared with pericardial effusions as a whole.…”

“…Other investigators 24 observed a relatively weak association of pericardial tamponade with low C4 (p=0.05), compared with pericardial effusions as a whole. In terms of pleurisy, in a Saudi Arabian cohort of 61 patients, 23 pleural effusion was associated with both low C3 and C4. …”

CCL21 and IP-10 as blood biomarkers for pulmonary involvement in systemic lupus erythematosus patients

“…5 The prevalence ranges from 4.9 to 50% in the adult population, while it is 5-67% in juvenile SLE according to previous studies, depending upon whether only symptomatic patients or detailed pulmonary examinations are included. [6][7][8] The disease might present with the first signs of pulmonary symptoms in about 4-5% of patients and lungs are frequently involved during the disease course. 9 Depending on the affected area, pulmonary manifestations include pleuritis, interstitial lung disease (ILD), airway disease, vascular or musculoskeletal involvement.…”

Year in review 2015: Lung cancer, pleural diseases, respiratory infections, bronchiectasis and tuberculosis, bronchoscopic intervention and imaging

“…In systemic lupus erythematosus, a disease charaterized by multiorgan involvement, the prevalence of pulmonary manifestations was found to be 33% among 184 patients from Western Saudi Arabia . The most common was pleural effusion that affected 50% of cases and was bilateral in 60%.…”