Pleuropulmonary manifestations in juvenile onset systemic lupus erythematosus: assessment by pulmonary function tests and multidetector computed tomography

ABSTRACT

Pulmonary involvement is a common finding in adults with systemic lupus erythematosus [SLE] also it is one of the most important systems that can be affected in Juvenile onset SLE [JOSLE]. Early detection and evaluation of the extent and severity of pulmonary involvement are quite critical for disease prognosis and patients management. To determine the frequency and type of pleuropulmonary involvement in JOSLE using pulmonary function tests [PFTs] and multidetector CT [MDCT]. Twenty five patients with JOSLE were evaluated for the detection of pleuropulmonary affection in them. The evaluation included clinical, functional and radiological examination using MDCT as a recent and accurate modality for chest imaging. Based on clinical evaluation, patients were divided into two groups; group A [No = 16] and group B [No = 9], consisting of those asymptomatic and symptomatic as regard pleuropulmonary symptoms, respectively. This study revealed that PFT abnormalities were detected in 60% of all studied JOSLE patients while MDCT abnormalities were detected in 52% of them. 37.5% of the asymptomatic patients had abnormal PFTs and 31.25% of them had abnormal findings on MDCT. There was statistically significant difference between patients groups regarding SLEDAI, percentages of abnormal PFTs, abnormalities in plain X-ray and MDCT. With the exception of forced expiratory flow at 25-75% of forced vital capacity [FEF[25-75%]], the study revealed statistically significant lower values of mean +/- SD of all measured PFTs in group B compared to group A. The most frequent MDCT findings in all studied patients were pleural effusion and pleural thickening in 16% of all findings, also ground glass opacities found in 16% of all abnormalities suggesting early interstitial lung disease. Clinical assessment and PFTs revealed a significant percentage of pleuropulmonary involvement in JOSLE patients. MDCT can be helpful in diagnosing the pulmonary involvement in asymptomatic JOSLE patients with normal chest X-ray and uncertain PFT