Pulmonary complications were common among patients with systemic lupus erythematosus (SLE) and can occur early in the disease course, a Swedish study found.
Compared with the general population, patients with incident SLE had a nearly 6-fold higher rate of noninfectious pulmonary disease (HR 5.8, 95% CI 4.8-7), according to Julia Simard, ScD, of the Karolinska Institute in Stockholm, and colleagues.
A similarly elevated risk was also seen among patients with prevalent SLE (HR 5.4, 95% CI 4.9-6), the researchers reported in Arthritis Research & Therapy.
When broken down by disease type, rates of potentially severe interstitial lung disease were the most common among both incident (HR 19, 95% CI 10.7-34) and prevalent cases (HR 14.3, 95% CI 10.8-18.8), which the researchers say suggests "that patients with SLE in the early stages of their disease experience interstitial lung disease at similar rates to those with longer standing disease."
"This is similar to what we see clinically with SLE," commented David Fernandez, MD, of the Lupus and Antiphospholipid Center of Excellence at the Hospital for Special Surgery in New York City, who wasn't involved with the study.
"Interstitial lung is a rare but serious manifestation of lupus, and it can arise at any point in the disease course. We also find that pulmonary manifestations of lupus are a source of substantial and potentially serious disease activity," he told MedPage Today.
Following right behind interstitial lung disease, the second most common type of lung disease was pulmonary hypertension, with hazard ratios of 6.1 (95% CI 3.2-11.8) and 6.8 (95% CI 4.7-9.6) for incident and prevalent cases, respectively.
"It is particularly interesting that the incidence of interstitial lung disease is similar to that of pulmonary embolism, which intuitively seems much more common," said Fernandez.
Some of the less frequent disease types seen among incident cases included pleural disorders (HR 5.9, 95% CI 4.4-7.9) and acute respiratory distress syndrome/hemorrhage (HR 5.3, 95% CI 2.7-10.5), as well as acute respiratory distress syndrome (HR 5.8, 95% CI 3.9-8.5) in the prevalent group.
Up to two-thirds of patients with SLE experience lung manifestations at some point, but incidence and prevalence rates are uncertain because previous studies have been limited to small numbers and short follow-up.
To address this question in a population-based cohort, and therefore more clearly quantify the burden of pulmonary disease in SLE, Simard and colleagues analyzed data on patients with SLE appearing in the Swedish National Patient Register, comparing them to the general non-SLE population in the Total Population Register.
The analysis included 3,209 incident SLE cases compared with 17,658 controls matched for sex, year of birth, and area of residence, and also included 6,908 prevalent cases compared with 37,046 matched controls. Incident cases of SLE consisted of diagnoses made from 2003 to 2013, while prevalent cases were diagnosed any time after January 2001. Mean age overall was 48, and 85% were women.
Pulmonary disorders included interstitial lung disease, acute respiratory distress syndrome/hemorrhage, pulmonary hypertension, edema, embolism, pleural disorders, and upper airway disease.
During a median 5-year follow-up, there were about 15 pulmonary complications per 1,000 person-years among the incident patients compared with less than 3 per 1,000 among matched controls. For prevalent patients, the incidence rate was nearly 14 per 1,000 person-years compared with less than 3 complications among controls.
Additional research is needed to follow the natural history of pulmonary disease in SLE patients in order to identify preventive strategies and appropriate interventions, the authors suggested.
"Clinicians caring for patients with SLE should have heightened suspicion of lung disease, including interstitial lung disease, even early within the disease course," they concluded.
Limitations of the study included the possibility of misclassification of SLE and pulmonary disease, as well as the relatively homogeneous Swedish population.
Simard is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH.
The authors reported no financial conflicts of interest.
Pulmonary, disease, rates, high in, lupus, medpage Today
Pulmonary complications were common among patients with systemic lupus erythematosus (SLE) and can occur early in the disease course, a Swedish study found. Systemic lupus erythematosus (SLE) is the most common connective tissue disease affecting the lung. 1 However, the reported prevalence of pulmonary involvement in SLE varies from 14 to how to Control Anger: 25 Tips to Manage Your Anger and Feel Calmer 100, depending on the criteria used to define lung abnormalities. 2 Previous studies in the Middle East have suggested the rate of pulmonary involvement. Various laboratory abnormalities have been described in SLE, most commonly high titre antibodies directed against double stranded DNA,1nuclear ribonucleoprotein, Smith (Sm) antigen, Ro/SS-A, and La/SS-B/Ha.2 Pleuritis occurs in 17-60 of patients at some point in the course of the disease.1. Treatment for...
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