Abstract
Introduction: Connective tissue diseases comprises several immunologic systemic disorders. The pleuro-pulmonary manifestations frequently occur in these patients. So the identification of the respiratory manifestations is a major concern.
Aim: To find out the prevalence of different respiratory manifestations in most common connective tissue disorders (systemic lupus erythematosus, Rheumatoid arthritis, Systemic sclerosis).
Methodology: A Hospital based cross-sectional, observational study conducted on 50 diagnosed cases of connective tissue diseases, of which 33 are SLE, 10 RA and 7 SSc. All these patients underwent clinical evaluation and Spirometry, Chest x-ray, HRCT scan of thorax and Echocardiography.
Results: Mean age of presentation was 32.9 and female: male 44:6. Spirometry showed restrictive change in 74% of total patients (72% of SLE , 70% of RA and 86% of SSc patients). From radiological point of view 38% of total patients had interstitial lung disease (20% of RA , 36% of SLE and 72% of SSc patients had HRCT findings suggestive of parenchymal lung diseases) followed by pleural effusion -10% of total patients (20%,6% and 40% patients of RA, SLE and SSc respectively). 28% of all the patients had mild pulmonary hypertension (20% of RA, 21% of SLE and 57% of SSc patients).
Conclusion: Regarding respiratory system, most of the patients in our study develop restrictive type of lung disease. Pulmonary hypertension occurs in patients with connective tissue diseases but not very common. Diffuse parenchymal lung disease, pleural effusions are dominant pleuropulmonary manifestations in our study.
Keyword: SLE, SSc, RA, Restrictive Lung Disease, ILD, Pulmonary Hypertension.
References
- El-Gabalawy H. Common denominators of inflammatory joint diseases. J Rheumatol Supp2005;72:3-6.
- Good JT Jr, King TE, Antony VB, et al: Lupus pleuritis: clinical features and pleural fluid characteristics with special reference to pleural fluid antinuclear antibodies. Chest 84:714–718, 1983.
- Matthay RA, Schwarz MI, Petty TL, et al: Pulmonary manifestations of systemic lupus erythematosus: review of twelve cases of acute lupus pneumonitis. Medicine 54:397–409, 1975.
- Bongartz T, Nannini C, Medina-Velasquez YF, et al: Incidence and mortality of interstitial lung disease in rheumatoid arthritis: a population-based study. Arthritis Rheum 62(6):1583–1591, 2010.
- Steen VD, Medsger TA: Changes in causes of death in systemic sclerosis, 1972-2002. Ann Rheum Dis 66:940–954, 2007.
- Badui E, Garcia-Rubi D, Robles E, Jimenez J, Juan L, Deleze M, et al. Cardiovascular manifestations in systemic lupus erythematosus: prospective study of 100 patients. Angiology 1985;36:431-4.
- Fenlon MM, Doran M, Sant SM, Breatnach E. High resolution chest CT in systemic lupus erythematosus. AJR Am J Roentgenol 1996;166:301-4.
- Gross M, Esterly JR, Earle RH. Pulmonary alterations in systemic lupus erythematosus. Am Rev Respir Dis 1992; 105:572-4.
- Huang CT, Hennigar GR, Lyons HA. Pulmonary dysfunction in systemic lupus erythematosus. New Engl J Med 1965;272:288-90.
- Murin S, Wiedemann HP, Mathay RA. Pulmonary manifestations of systemic lupus erythematosus. Clin Chest Med 1998;19:645-65.
- Winslow JM, Ossipor MA, Fazio GP, Simonson JH, Redberg RF, Schiller NB, et al. Five year follow up study of the prevalence and progression of pulmonary hypertension in systemic lupus erythematosus. Am Heart J 1995;129:510-4.
- King TE. Connective tissue disease. In: Schwarz MI, King TE, editors. Interstitial Lung Disease. 3rd edition. Hamilton, Ontario: BC Decker Inc. 1998;pp451-505.
- Light R. Pleural disease due to collagen vascular disease. In: Pleural Diseases. 2nd edition. Philadelphia: Lea and Febiger. 1990;pp205-15.
- Shiel WO, Prete PE. Pleuro-pulmonary manifestations of rheumatoid arthritis. Sem Arthritis Rheum 1982;58:187-9.
- Walker WC, Wrightt V. Pulmonary lesions and rheumatoid arthritis. Medicine 1982;58:187-9.
- Gabbay E, Tarala R, Will R, Carrol G, Adler B, Cameron D, et al. Interstitial lung disease in recent onset rheumatoid arthritis. Am J Respir Crit Care Med 1997;156:528-35
- Fujii M, Adachi S, Shimizu T. Interstitial lung disease in rheumatoid arthritis: assessment with high resolution computed tomography. J Thorac Imag 1993;8:54-62.
- Shannon JM, Gale ME. Noncardiac manifestations of rheumatoid arthritis in the thorax. J Thorac Imag 1992;7: 19-29.
- Minai OA, Dweik RA, Arroliga AC. Manifestations of scleroderma pulmonary diseases. Clin Chest Med 1998; 19:713-31.
- Wiedemamn HP, Matthay RA. Pulmonary manifestations of collagen vascular diseases. Clin Chest Med 1989;10:677- 721.
- Sergiacomi G,De Nardo D, Capria A, Manenti G,Fabiano S,Borzi M,De Sanctis G,Konda D,Sperandio M,Schillaci O,Masala S,Simonetti G,Fontana L. Noninvasive diagnostic and functional evaluation of cardiac and pulmonary involvement in systemic sclerosis. In Vivo. 2004 Mar-Apr;18(2):229-35.
Corresponding Author
Dr Ankan Saha
Junior Resident, Department of Medicine, Medical College and Hospital, Kolkata, India
DOI: https://dx.doi.org/10.18535/jmscr/v8i1.35
