Subclinical pleuro-pulmonary disease in patients with SLE: functional and radiological methods

Abstract

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with highest prevalence of chest involvement; however, early detection of subclinical pleuropulmonary diseases may improve the quality of life and prognosis of patients. This study aimed to identify the subclinical pleuro-pulmonary involvement in SLE patients without respiratory symptoms. A total of 228 patients diagnosed with SLE were recruited and subjected to high-resolution computed tomography (HRCT) chest, ultrasound (US) chest, and spirometry for further evaluation and finding of sub-clinical signs. Around 52.63% of patients had pulmonary involvement in HRCT, while in US, it was 73.68%. Ground glass opacity was observed in 31.58% of HRCT cases, and > 1/3 of patients had pleural thickness in US. Spirometry showed that 26.32% of patients had small airway disease. SLE patients with subclinical lung involvement were significantly female and younger and had shorter disease duration, p < 0.05 for all. SLE severity showed a significant negative correlation with lung function, and was positively correlated with pleural thickness and effusion, and pleural nodules in US finding. However, diaphragmatic excursion showed a negative correlation. Moreover, ground glass opacities, honey combing opacities, interlobular septal thickening, pleural thickness, and effusion in HRCT showed positive correlation with disease severity, p < 0.001 for all, yet, the mosaic pattern showed a negative relationship. The radiological assessments of SLE patients via HRCT and ultrasound unveiled prevalent findings such as ground glass opacities and pleural abnormalities. The severity of SLE correlated significantly with pulmonary function tests in a negative way, plus the positive correlation with lung opacities and pleural abnormalities.