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The Egyptian Journal of Bronchology
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  • Interstitial lung diseases and lung in systemic diseases
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Pulmonary involvement in juvenile-onset systemic lupus erythematosus patients asymptomatic for respiratory disease

Egyptian Journal of Bronchology volume 9, pages 59–63 (2015)Cite this article

Abstract

Objective

The aim of this study was to investigate the presence and frequency of abnormalities in subclinical pulmonary function tests (PFTs) in a group of Egyptian children with juvenile-onset systemic lupus erythematosus (jSLE) asymptomatic for respiratory manifestations.

Patients and methods

The study enrolled 20 children with jSLE followed up at the Pediatric Rheumatology Clinic, Cairo University. For all patients, pulmonary function testing was performed including measurement of lung volumes and lung flows using spirometry. Lung diffusion testing was performed using the transfer factor of the lung for carbon monoxide (DLCO) utilizing the single-breath method. Findings were correlated with clinical manifestations and lupus disease activity, and assessed using Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores.

Results

NAmong our study group, musculoskeletal, mucocutaneous, hematologic, renal, and neurological manifestations were the most frequent lupus manifestations throughout the course of disease, occurring in 85, 80, 65, 45, and 35% of the patients, respectively. The mean SLEDAI score was 21.3 ± 9.515. Overall, 95% our patients had at least one PFT abnormality within a mean of 4.9 ± 1.94 years after disease onset. Diffusion defect was the most frequent defect detected in 14 (70%) patients, restrictive pathology was found in seven (35%) patients, obstructive pathology was found in six (30%) patients, and mixed restrictive and obstructive pathology in one (5%) patient. In terms of the correlation between PFTs and the SLEDAI, DLCO was correlated positively (r = 0.37, P = 0.05) to a high SLEDAI, that is, a diffusion defect was significantly evident in patients with high disease activity even without symptoms.

Conclusion

Occult pulmonary disease as shown by a PFT occurs frequently in our group of Egyptian patients with childhood-onset systemic lupus erythematosus.

References

  1. Alonso MD, Llorca J, Martinez-Vazquez F, Miranda-Filloy JA, Diaz de Teran T, Dierssen T, et al. Systemic lupus erythematosus in northwestern Spain: a 20-year epidemiologic study. Medicine (Baltimore) 2011; 90:350–358.

    Article  Google Scholar 

  2. Ciftçi E, Yalçinkaya F, Ince E, Ekim M, Ileri M, Orgerin Z, et al. Pulmonary involvement in childhood-onset systemic lupus erythematosus: a report of five cases. Rheumatology (Oxford) 2004; 43:587–591.

    Article  Google Scholar 

  3. Trapani S, Camiciottoli G, Ermini M, Castellani W, Falcini F. Pulmonary involvement in juvenile systemic lupus erythematosus: a study on lung function in patients asymptomatic for respiratory disease. Lupus 1998; 7:545–550.

    Article  CAS  Google Scholar 

  4. Nakano M, Hasegawa H, Takada T, Ito S, Muramatsu Y, Satoh M, et al. Pulmonary diffusion capacity in patients with systemic lupus erythematosus. Respirology 2002; 7:45–49.

    Article  Google Scholar 

  5. Sant SM, Doran M, Fenelon HM, Breatnach ES. Pleuropulmonary abnormalities in patients with systemic lupus erythematosus: assessment with high resolution computed tomography, chest radiography and pulmonary function tests. Clin Exp Rheumatol 1997; 15:507–513.

    CAS  PubMed  Google Scholar 

  6. Silberstein SL, Barland P, Grayzel AI, Koerner SK. Pulmonary dysfunction in systemic lupus erythematosus: prevalence classification and correlation with other organ involvement. J Rheumatol 1980; 7:187–195.

    CAS  PubMed  Google Scholar 

  7. Chick TW, DeHoratius RJ, Skipper BE, Messner RP. Pulmonary dysfunction in systemic lupus erythematosus without pulmonary symptoms. J Rheumatol 1976; 3:262–268.

    CAS  PubMed  Google Scholar 

  8. Al-Abbad AJ, Cabral DA, Sanatani S, Sandor GG, Seear M, Petty RE, Malleson PN. Echocardiography and pulmonary function testing in childhood onset systemic lupus erythematosus. Lupus 2001; 10:32–37.

    Article  CAS  Google Scholar 

  9. Petri M. Review of classification criteria for systemic lupus erythematosus. Rheum Dis Clin North Am 2005; 31:245–254, vi.

    Article  Google Scholar 

  10. Lattanzi B, Consolaro A, Solari N, Ruperto N, Martini A, Ravelli A. Measures of disease activity and damage in pediatric systemic lupus erythematosus: British Isles Lupus Assessment Group (BILAG), European Consensus Lupus Activity Measurement (ECLAM), Systemic Lupus Activity Measure (SLAM), Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), Physician’s Global Assessment of Disease Activity (MD Global), and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR DI; SDI). Arthritis Care Res (Hoboken) 2011; 63:S112–S117.

    Article  Google Scholar 

  11. Harris EN, Pierangeli SS. Revisiting the anticardiolipin test and its standardization. Lupus 2002; 11:269–275.

    Article  CAS  Google Scholar 

  12. Lakos G, Favaloro EJ, Harris EN, Meroni PL, Tincani A, Wong RC, Pierangeli SS. International consensus guidelines on anticardiolipin and anti-β2-glycoprotein I testing: report from the 13th International Congress on Antiphospholipid Antibodies. Arthritis Rheum 2012; 64:1–10.

    Article  Google Scholar 

  13. Wanger J, editor. Pulmonary function testing; a practical approach. 1st ed. Baltimore: Williams and Wilkins; 1992.

    Google Scholar 

  14. Madama, V, editor. Pulmonary function testing and cardiopulmonary stress testing. 2nd ed. USA: Delmar Publishers; 1998.

  15. Neas LM, Schwartz J. The determinants of pulmonary diffusing capacity in a national sample of U.S. adults. Am J Respir Crit Care Med 1996; 153:656–664.

    Article  CAS  Google Scholar 

  16. Salah S, Lotfy HM, Sabry SM, El Hamshary A, Taher H. Systemic lupus erythematosus in Egyptian children. Rheumatol Int 2009; 29:1463–1468.

    Article  Google Scholar 

  17. Delgado EA, Malleson PN, Pirie GE, Petty RE. The pulmonary manifestations of childhood onset systemic lupus erythematosus. Semin Arthritis Rheum 1990; 19: 285–293.

    Article  CAS  Google Scholar 

  18. De Jongste JC, Neijens HJ, Duiverman EJ, Bogaard JM, Kerrebijn KF. Respiratory tract disease in systemic lupus erythematosus. Arch Dis Child 1986; 61:478–483.

    Article  Google Scholar 

  19. Cerveri I, Fanfulla F, Ravelli A et al. Pulmonary function in children with systemic lupus erythematosus. Thorax 1996; 51:424–428.

    Article  CAS  Google Scholar 

  20. Al-Abbad AJ, Cabral DA, Sanatani S, Sandor GG, Seear M, Petty RE, Malleson PN. Echocardiography and pulmonary function testing in childhood onset systemic lupus erythematosus. Lupus 2001; 10:32–37.

    Article  CAS  Google Scholar 

  21. Decramer M, Lacquet LM, Fagard R, Rogiers P. Corticosteroids contribute to muscle weakness in chronic airflow obstruction. Am J Respir Crit Care Med 1994; 150:11–16.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Faculty of Medicine, Cairo University, 23 Dr. Naguib Mahfouz Street, Nasr City, Cairo, 11471, Egypt

    Hala M. Lotfy, Eman F. Halawa MD & Mohamed El Baz

Authors
  1. Hala M. Lotfy
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  2. Eman F. Halawa MD
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  3. Mohamed El Baz
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Correspondence to Eman F. Halawa MD.

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Lotfy, H.M., Halawa, E.F. & El Baz, M. Pulmonary involvement in juvenile-onset systemic lupus erythematosus patients asymptomatic for respiratory disease. Egypt J Bronchol 9, 59–63 (2015). https://doi.org/10.4103/1687-8426.153620

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  • DOI: https://doi.org/10.4103/1687-8426.153620

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