Systemic lupus erythematosus in a multiethnic US Cohort LUMINA XLVIII: factors predictive of pulmonary damage

Abstract

The objective of this study was to determine the factors predictive of time to the occurrence of pulmonary damage in systemic lupus erythematosus (SLE). Six-hundred and twenty-six SLE patients from a multiethnic (Hispanics, African Americans and Caucasians) longitudinal study of outcome were studied. Pulmonary damage was defined as per the Systemic Lupus International Collaborating Clinics Damage Index. Socioeconomic-demographic, clinical, genetic, serological features, pharmacologic treatments, behavioural, psychological and disease activity [as per the Systemic Lupus Activity Measure-Revised (SLAM-R)] were examined. Factors associated with time to the occurrence of pulmonary damage were examined by Cox proportional hazards regressions. A Kaplan-Meier survival curve was also examined. Forty-six (7.3%) patients had pulmonary damage after a mean (SD) total disease duration of 5.3 (3.6) years. Among those patients, 25 had pulmonary fibrosis, 12 pulmonary hypertension, eight pleural fibrosis, four pulmonary infarction and four shrinking lung syndrome. Seven patients had more than one type of lung damage. Cumulative rates of pulmonary damage at five and 10 years were 7.6% and 11.6%, respectively. In the multivariable analyses, age (HR = 1.033, 95% CI 1.006-1.060; P = 0.0170), pneumonitis (HR = 2.307, 95% CI 1.123-4.739; P = 0.0229) and anti-RNP antibodies (HR = 2.344, 95% CI 1.190-4.618; P = 0.0138) were associated with a shorter time to the occurrence of pulmonary damage while photosensitivity (HR = 0.388, 95% CI 0.184-0.818; P = 0.0128) and oral ulcers (HR = 0.466, 95% CI 0.230-0.942; P = 0.0335) with a longer time. Pulmonary damage is relatively common in SLE. Age, pneumonitis and anti-RNP antibodies were associated with a shorter time to the development of permanent lung disease.

Exercise‐induced pulmonary hypertension associated with systemic sclerosis: Four distinct entities

“…The prevalence of resting PAH in CTD is ϳ2.3-10 cases per million (5), typically mostly SSc patients (5-50%) (6)(7)(8)(9)(10)(11)(12), patients with mixed CTD (21-29%) (13), and patients with systemic lupus erythematosus (5-43%) (14)(15)(16). Based on right heart catheterization, the prevalence of resting PAH in SSc is likely 7.9-20% (7,17).…”

Severe hypoxemia without pulmonary infiltrates in systemic lupus erythematosus

“…Patients with patient who discontinue sildenafil can decompensate. 18 Increased PA pressure secondary to vasoconstriction and/or small emboli could increase right to left shunting and cause refractory hypoxemia.…”

Auto-antigenic Properties of the Spliceosome as a Molecular Tool for Diagnosing Systemic Lupus Erythematosus and Mixed Connective Tissue Disease Patients

“…given that auto-antigenicity against U1Ap has been associated with lung disease in SLE and MCTD patients (Nishimaki et al, 1999;Bertoli et al, 2007;Cojocaru et al, 2011;Lian et al, 2012) and has even been shown to be elevated in three different types of lung cancer (Zhang et al, 2005 and2008). Aside from these associations, no study has recorded the predicted accuracy of these correlations and, as a result, chest radiography has been the suggested method to diagnose lung injury (Levitt et al, 2013).…”