A Hospital Based study on Pulmonary Manifestations of Systemic Lupus Erythematosus

Murali, R (2006) A Hospital Based study on Pulmonary Manifestations of Systemic Lupus Erythematosus. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Systemic Lupus Erythematosus (SLE) is an autoimmune disease in which organs, tissues, and cells undergo damage mediated by tissuebinding auto-antibodies and immune complexes. Many of its clinical manifestations are secondary to the trapping of antigen-antibody complexes in capillaries of visceral structures or to auto antibody-mediated destruction of host cells. The clinical course is marked by spontaneous remission and relapses. The severity may vary from a mild episodic disorder to a rapidly fulminant, life -threatening illness. The lungs may conveniently be considered in six main regions: the pleural space, the parenchyma, the pulmonary vasculature, the airways, the diaphragm, and the chest wall including the ribs and respiratory muscles. Systemic Lupus Erythematosus (SLE) and the adverse effects of various therapies may affect all these regions of the chest. Pulmonary involvement is common in SLE and will affect half of patients during the disease course and is part of the spectrum of presenting symptoms in 4% to 5% of patients. Primary involvement of the lung and pleurae is common in SLE. The clinical presentation are protean and sometimes are presenting feature of the disease. Subclinical involvement also is prevalent, as shown by the high frequency of the abnormal pulmonary function test results in patient who are free from respiratory complaints. Furthermore, other complications of lupus such as cardiac failure or nephritic syndrome may lead to lung involvement with the development of pleural effusions. Pulmonary involvement may increase the risk of mortality; in one study, lung involvement was one of several factors that was predictive for increased mortality. The prevalence of pulmonary manifestations in SLE depends on the referral pattern to the unit where patients are studied, the population under scrutiny, and the methods used to detect pulmonary involvement. This study has been conducted to evaluate the pulmonary manifestations in SLE patients and to correlate the clinical features with radiographic findings and pulmonary function tests. The usefulness of the high resolution computed tomography (HRCT), which is reported to be promising in the diagnosis, and the disease activity in the lung parenchyma, needs a special mention. AIM OF THE STUDY: 1. To study the prevalence of respiratory abnormalities in Systemic Lupus Erythematosus. 2. To correlate the clinical features with Plain radiographs, Pulmonary function tests (PFT) and high resolution computed tomography (HRCT). MATERIALS AND METHODS: Data for the study were collected from patients diagnosed to have SLE and attending regular follow up at the Department of Rheumatology, and at the Institute of Internal Medicine, Madras Medical College and Research Institute, Chennai. The above patients were investigated for Pulmonary abnormalities at the Department of Rheumatology and the Institute of Internal Medicine. Serological investigations were done at the Immunology Department. Pulmonary Function testing was done at Institute of Internal Medicine. High resolution Computed tomography was carried out in the Barnard Institute of Radiation and Oncology (BIRO), Madras Medical College. Study Period: The study was conducted during the period Feb 2005 to Feb 2006. Thirty SLE patients were enrolled for the study after satisfying inclusion and exclusion criteria. After enrollment, the patients were evaluated for the presence of pulmonary abnormalities. Study Design: To evaluate the pulmonary profile in patients with SLE, prospective study design was chosen. The cases were selected based on inclusion and exclusion criteria. Case Identification and Validation: Patients who were diagnosed to have SLE and were attending the Department of Rheumatology and the Institute of Internal Medicine for regular follow up during the period Feb 2005–Feb 2006 were examined and the possibility of inclusion in our study and evaluated. Patients were diagnosed as having SLE based on the American College of Rheumatology (ACR) criteria. 1. Malar Rash, 2. Discoid Rash, 3. Photosensitivity, 4. Oral ulcers, 5. Arthritis, 6. Serositis, 7. Renal Disorder, 8. Neurologic Disorder, 9. Hematologic Disorder, 10. Immunologic Disorder. 11. Antinuclear Antibodies(ANA) If four of these criteria are present at any time during the course of disease, a diagnosis of Systemic Lupus can be made. Inclusion Criteria: A patient with SLE diagnosed on the basis of the American College of Rheumatology (ACR) criteria. Exclusion Criteria: The following patients were excluded from the study. 1. Smokers, 2. COPD, 3. Pulmonary Tuberculosis(PT), 4. Bronchial asthma, 5. Chronic Lung disease, 6. Patients with exposure to dusts. RESULTS: Among the thirty patients who were enrolled for the study, 27 were females and 3 were males (Female: Male ratio 9:1). The mean age was 26 years, the youngest patient being 12 years and oldest patient being 53 years. Patients had the disease for an average period of 3 years. The duration of respiratory symptoms varied from 1 month to 1 year, the average duration being 6 month. Out of the thirty Patients, 20 were symptomatic (66%). The predominant symptoms was breathlessness, which was present in 18 patients (60%). Cough was the presenting complaint in 8 patients (30%). The other symptoms were fever, pleuritic chest pain, and generalized weakness. Clinical examination revealed abnormal findings in only 13 patients (43%). Two patients, who were admitted with fever and cough had high pitched bronchial breath sounds bilaterally, suggesting the impression of pneumonitis (6%). Two patients had diminished intensity of breath sounds (6%). Nine patients had fine respiratory basal crepitations (30%). In the remaining 17 patients, clinical examination was normal. CONCLUSION: Respiratory abnormalities were present in 66% of patients with SLE. • The longer the duration of the disease, the more the likelihood of pulmonary pathology. • The commonest respiratory abnormality was found to be of early ILD, with ground glass pattern in HRCT. • HRCT evidence of ILD was frequently present despite absence of symptoms and normal chest radiograph. • Most patients had abnormalities in their PFT but did not demonstrate anatomically abnormality. Reduction in lung volumes was the most common finding, suggestive of restrictive patten of ILD. • HRCT was more sensitive in detecting anatomical abnormalities than any other non –invasive investigatory modality. SUMMARY: A Prospective study of respiratory abnormalities in systemic lupus erythematosus was done to correlate the clinical features with plain radiographs, pulmonary function test and HRCT. Thiry, SLE patients were questioned about their symptoms of respiratory disease or not. After clinical examination, patient underwent lab investigations and imaging modalities. On analyzing the results from the study two-thirds of the patients had respiratory abnormalities. It was found that longer the duration of the disease, more likelihood of developing pulmonary pathology. HRCT is more sensitive in detecting the anatomical abnormalities than any other non–invasive investigating modality.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Pulmonary Manifestations ; Systemic Lupus Erythematosus ; Hospital Based study.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 25 Mar 2018 02:06
Last Modified: 25 Mar 2018 03:23
URI: http://repository-tnmgrmu.ac.in/id/eprint/6547

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