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AB0507 Early Detection of Asymptomatic Pleuropulmonary Manifestations in Systemic Lupus Erythematosus by High Resolution CT and Pulmonary Function Tests
  1. S.M. Ghanem,
  2. M.M. Ghanem,
  3. M.A. Hegazy,
  4. E. Abo Elftouh,
  5. A. Negm,
  6. S. Daabous
  1. Rheumatology, Faculty of Medicine, Cairo, Egypt

Abstract

Background (SLE) is a prototype of an autoimmune disease with a broad variety of clinical manifestations, particularly affecting the kidneys and the central nervous system. Autoantibodies against double strand DNA (Anti ds DNA) and a number of other nuclear and cytoplasmic antigens as well as spontaneous immunoglobulin producing cells are characteristic of SLE, reflecting an aberrant immune response (1). Patients may manifest serious and life threatening complications of the disease with relapses and remissions (2). Thoracic manifestations of the rheumatic diseases (RDs) are a significant cause of morbidity and mortality worldwide. The five RDs most frequently associated with pleuropulmonary disease are: Rheumatoid arthritis (RA), (SLE), Progressive systemic sclerosis (PSS), Polymyositis/dermatomyositis (PM/ DM), Sjogren syndrome (SS). The clinical presentation is highly variable, ranging from pleuritic pain alone to slowly progressive breathlessness accompanied by cough. On occasion RD may present acutely with overwhelming respiratory failure as the first pulmonary manifestation (3). Asymptomatic involvement is more common and abnormalities in pulmonary function tests have been cited in up to two thirds of patient with SLE in some studies.

Objectives The aim of this study is the early detection of asymptomatic pleuropulmonary manifestation of systemic lupus erythematosus using high resolution CT and pulmonary function tests.

Methods During study period (May 2013 to June 2015), 30 SLE patients (29 female and 1 male) were included in this prospective study. The patients were diagnosed according to the American College of Rheumatology criteria for the classification of SLE. All patients were asymptomatic for any pulmonary manifestations. Plain chest X-ray, HRCT and pulmonary functiontests (PFTs) were performed for all patients. Analysis of data was done by Compaq computer using SPSS (statistical program for social science version 14).

Results The high resolution CT findings in the studied patients were positive in 12 (40%) out of 30 patients and negative in 18 (60%) out of 30 patients. The plain x-ray finding in the studied patients were positive in 3 (10%) out of 30 patients. The pulmonary function tests were as the following: restrictive disease in 5 (16.7%) out of 30 patients, the rest of patients were normal and no obstructive disease

Conclusions The pulmonary manifestations are present in SLE patients even in asymptomatic cases, at some point of time during the course of the disease. Some of these manifestations may remain asymptomatic. The use of CT scan and pulmonary function tests will help in early recognition and introduction of the therapy will help in preventing the morbidity and mortality in such cases.

  1. Odendahl, M., Keitzer, R., Wahn, U., et al (2003): Perturbations of peripheral B lymphocyte homoeostasis in children with systemic lupus erythematosus. Annals of the Rheumatic Diseases; 62:851–858.

  2. Fernando MM and Isenberg DA. (2005): How to monitor SLE in routine clinical practice.Annals of the Rheumatic Diseases; 64:524–527.

  3. Leslie KO, Sylvain Trahan, and James Gruden (2007): pulmonary pathology of rheumatic diseases. Critical Care Medicine; 28(4): 369–378

  4. Michael P Keane, and Joseph P (2000): Pleuropulmonary manifestations of systemic lupus Erythematosus.Thorax;55:159–166.

Disclosure of Interest None declared

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