Respiratory function in systemic lupus erythematosus: relation with activity and severity

Abstract

The objective of this study was to examine the relation between respiratory function tests, disease activity and disease severity in ambulatory patients with systemic lupus erythematosus (SLE) who did not present with overt respiratory problems. Lung volumes, maximal expiratory flows at 50% and 25% of vital capacity (MEF50 and MEF25), bronchial threshold to methacholine (PD15FEV1), transfer factor CO (KCO) were measured in 24 consecutive SLE outpatients (22 women, age 41 +/- 14.8 years) and in 24 healthy controls matched for age and sex. In SLE patients alveolar-arterial oxygen gradient (AaO2) was also measured. Disease activity was assessed by European Consensus Lupus Activity Measurement (ECLAM) scoring system and disease severity by Lupus Severity of Disease Index. In comparison to controls SLE patients showed a significant decrease of total lung capacity (TLC) (91.7 +/- 16.5 vs 102.7 +/- 12.9% predicted, P < 0.01), MEF25 (58.4 +/- 25.2 vs 73.5 +/- 19.5% predicted, P < 0.005) PD15FEV1 (2164 +/- 1122 vs 4230 +/- 1014 micrograms methacholine, P < 0.0001) and KCO (77.1 +/- 20.5 vs 96.3 +/- 12.4% predicted, P < 0.001). AaO2 (mean value 13.2 +/- 8.4) was abnormally high (> 20 mmHg) in 12 patients. The ECLAM score of activity was inversely related with KCO (r = 0.48, P < 0.02). The severity index was significantly related with FEV1/VC ratio (r = 0.43, P < 0.05), MEF50 (r = 0.51, P < 0.01), MEF25 (r = 0.40, P < 0.05) and PD15FEV1 (r = 0.51, P < 0.01). In eight patients, evaluated also after treatment intensification, there was a significant increase in KCO (from 71.8 +/- 24.7 to 84.9 +/- 22.3% predicted, P < 0.01) along with a decrease in ECLAM score (from 3.0 +/- 1.34 to 0.69 +/- 0.75, P < 0.01). The relation between disease activity and KCO suggests a relation between systemic and alveolar inflammation whereas the relation between severity index, airway patency and reactivity indices suggests a cumulative damage to the airways in SLE patients, even in the absence of overt respiratory manifestations.

Is hydroxychloroquine effective in treating primary Sjogren’s syndrome: a systematic review and meta-analysis

“…The remaining papers were analyzed, and from these, eight reviews, 27 conference summaries, three case reports, eight articles not in English and two articles with no pertinent full text were excluded. Finally, four studies [31, 37, 39, 40] were included in this review (Fig. 1).…”

“…A total of 215 SS patients were included in this review. One [31] of the four studies did not use a control group. The sample size ranged from 19 to 120 patients in each study.…”

“…The efficacy of HCQ in the treatment of SLE [29] and RA [30] is already widely recognized, but its efficacy in the treatment of pSS is in dispute. Some studies have shown that it is effective in the treatment of pSS [31–33]. It is commonly used to treat fatigue, arthralgia, and myalgia [22, 34–36].…”

Respiratory involvement in systemic lupus erythematosus

“…Initial damage to the small airways (defined as MEFV 25-75 below 60% of predicted value) is frequent (24%), with no difference between patients with lupus and the control group (patients free of any respiratory disease and matched for smoking) [56]. However, surveillance of pulmonary function tests for two to seven years revealed a progressive decline in values indicating small airways damage with time, independent of smoking [38,58].…”

Fvc, Fev1 and Fev1/Fvc % in Female SLE Patients and Their Relationship with Duration of the Disease

“…Several investigators of different countries abroad reported lower spirometric lung variables in SLE patients 6,8,9,10, which might be decreased with duration of disease 11,12,13 .…”