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Respiratory function in systemic lupus erythematosus: relation with activity and severity

Dipartimento di Science Biomediche e Oncologia Umana, University of Torino, via Genova 3, 10216 Torino, Italy

L. Brussino

Dipartimento di Science Biomediche e Oncologia Umana, University of Torino, via Genova 3, 10216 Torino, Italy

MT Bertero

Dipartimento di Science Biomediche e Oncologia Umana, University of Torino, via Genova 3, 10216 Torino, Italy

C. Bucca

Dipartimento di Science Biomediche e Oncologia Umana, University of Torino, via Genova 3, 10216 Torino, Italy

M. Converso

Dipartimento di Science Biomediche e Oncologia Umana, University of Torino, via Genova 3, 10216 Torino, Italy

F. Caligaris-Cappio

Dipartimento di Science Biomediche e Oncologia Umana, University of Torino, via Genova 3, 10216 Torino, Italy

The objective of this study was to examine the relation between respiratory function tests, disease activity and disease severity in ambulatory patients with systemic lupus erythematosus (SLE) who did not present with overt respiratory problems. Lung volumes, maximal expiratory flows at 50% and 25% of vital capacity (MEF₅₀ and MEF₂₅), bronchial threshold to methacholine (PD₁₅FEV ₁), transfer factor CO (KCO) were measured in 24 consecutive SLE outpatients (22 women, age 41 ± 14.8 years) and in 24 healthy controls matched for age and sex. In SLE patients alveolar-arterial oxygen gradient (AaO₂) was also measured. Disease activity was assessed by European Consensus Lupus Activity Measurement (ECLAM) scoring system and disease severity by Lupus Severity of Disease Index. In comparison to controls SLE patients showed a significant decrease of total lung capacity (TLC) (91.7 ± 16.5 vs 102.7 ± 12.9% predicted, P < 0.01), MEF₂₅ (58.4 ± 25.2 vs 73.5 ± 19.5% predicted, P < 0.005), PD₁₅FEV₁ (2164 ± 1122 vs 4230 ± 1014 µg methacholine, P < 0.0001) and KCO (77.1 ± 20.5 vs 96.3 ± 12.4% predicted, P < 0.001). AaO₂ (mean value 13.2 ± 8.4) was abnormally high (>20 mm Hg) in 12 patients. The ECLAM score of activity was inversely related with KCO (r = 0.48, P < 0.02). The severity index was significantly related with FEV₁/VC ratio (r = 0.43, P < 0.05), MEF₅₀ (r = 0.51, P < 0.01), MEF₂₅ (r = 0.40, P < 0.05) and PD₁₅FEV₁ (r = 0.51, P < 0.01). In eight patients, evaluated also after treatment intensification, there was a significant increase in KCO (from 71.8 ± 24.7 to 84.9 ± 22.3% predicted, P < 0.01) along with a decrease in ECLAM score (from 3.0 ± 1.34 to 0.69 ± 0.75, P < 0.01).

The relation between disease activity and KCO suggests a relation between systemic and alveolar inflammation whereas the relation between severity index, airway patency and reactivity indices suggests a cumulative damage to the airways in SLE patients, even in the absence of overt respiratory manifestations.

Key Words: airway hyper-responsiveness • respiratory function

Lupus, Vol. 5, No. 1, 38-43 (1996)
DOI: 10.1177/096120339600500108


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