Pleuropulmonary Manifestations in Patients with Systemic Lupus Erythematosus
Authors: Iaremenko O.B. , Koliadenko D.I. , Iaremenko K.M. , Kozak N.D. , Dema O.V. 
Published: September 2024

Objective — to assess the prevalence of non-infectious pleuropulmonary manifestations in patients with systemic lupus erythematosus (SLE), as well as the demographic, clinical and laboratory characteristics of such patients.
Materials and methods. A total of 435 patients with SLE (87.5 % female; median age 37 (26—49) years) were enrolled in a cross-sectional study, including 200 with pleuropulmonary manifestations and 235 without them. Patients were evaluated for demographic details, clinical SLE manifestations, SLE Disease Activity Index 2000 (SLEDAI-2K), SLICC/ACR Damage Index (DI). Laboratory evaluations included complete blood count with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), high-sensitivity CRP (hs-CRP), interleukin-6 (IL-6), IL-10, complement C3 and C4 levels, specific autoantibodies. Procalcitonin and presepsin serum levels were measured to exclude infections.
Results and discussion. At least one pleuropulmonary manifestation occurred in 46 % of patients, with pleurisy being the most frequent (24 %). Respiratory involvement was associated with male sex, longer disease duration, and older age at disease onset. Patients with respiratory complications had higher SLEDAI-2K and SLICC/ACR DI scores than those without pleuropulmonary involvement. Patients with pleuropulmonary manifestations more frequently exhibited lymphadenopathy, nephritis, pericarditis, other cardiac manifestations, fever, weight loss, anemia, and thrombocytopenia; conversely, cutaneous manifestations occurred less frequently in patients with pleuropulmonary involvement. Patients with respiratory involvement were found to have higher levels of ESR, CRP, hs-CRP, and IL-6. A higher frequency of positive anti-La/SSB, antiphospholipid, and anti-chromatin antibodies was observed in patients with pleuropulmonary manifestations compared to those without them.In multivariate logistic analysis, respiratory involvement was positively associated with older age (odds ratio (OR) 1.03 (95 % confidence interval (CI) 1.01—1.05), p = 0.004), higher SLEDAI-2K (OR 1.05 (95 % CI 1.01— 1.09), p = 0.030) and SLICC/ACR DI scores (OR 11.34 (95 % CI 1.03—1.74), p = 0.027), presence of lymphadenopathy (OR 2.27 (95 % CI 1.33—3.88), p = 0.003), pericarditis (OR 4.40 (95 % CI 2.29—8.46), p < 0.001), other cardiac manifestations (OR 10.1 (95 % CI 5.65—17.9), p < 0.001), and systemic symptoms (OR 2.14 (95 % CI 1.24—3.70), p = 0.007). Cutaneous manifestations were, on the other hand, negatively associated with the occurrence of pleuropulmonary symptoms (OR 0.27 (95 % CI 0.15—0.50), p < 0.001).
Conclusions. Pleuropulmonary manifestations are frequent in SLE, particularly pleuritis. Respiratory involvement is associated with male sex, older age, longer disease duration, and occurs mainly in patients with active and severe lupus, often with previous or concomitant major organ involvement other than lungs. Patients with pleuropulmonary involvement have higher levels of inflammatory markers and higher frequency of positive anti-La/SSB, antiphospholipid, and anti-chromatin antibodies.