High resolution computed tomography and pulmonary function tests in childhood systemic lupus erythematosus and juvenile rheumatoid arthritis

Abstract

Background: Alveolar and airway injury represent one of the most common features of rheumatological diseases and is believed to have a significant impact on the course of these diseases. Objective: This work aimed at evaluating airway and alveolar involvement in children with systemic lupus erythematosus (SLE) and juvenile rheumatoid arthritis (JRA). Methods: Thirty four children (21 with SLE and 13 with JRA) were assessed by pulmonary function tests (PFTs) namely spirometry and carbon monoxide diffusion capacity (DLCO) in comparison to 10 healthy controls, as well as by plain roentgenography and high resolution computed tomography (HRCT) of the chest. Results: The studied patients had significantly lower mean PFT values as compared to controls. A restrictive pattern of PFTs was more common as it was detected in 62% of patients with SLE and 23% of those with JRA whereas an obstructive pattern was detected in 14% and 8% respectively. Significantly lower FEF 25-75% values were detected in symptomatic patients. Low values of DLCO (less than 80% of predicted) were recorded in 60% of the studied patients. Chest HRCT was abnormal in 68% of studied patients. In SLE, ground glass appearance and pleural irregularity were the most common findings whereas in JRA, bronchial wall thickening, mosaic appearance and air trapping were prominent. Abnormal findings were detected in 5/9 of asymptomatic patients. Conclusion: airway and alveolar abnormalities are frequently encountered in children with SLE (95%) and JRA (85%) even if they are asymptomatic. HRCT and pulmonary function tests including diffusion studies are recommended as useful tools for the diagnosis and early detection of pulmonary involvement in these patients.

Keywords: JRA, SLE, HRCT, PFTs, DLCO

Egypt J Pediatr Allergy Immunol 2004; 2(1): 8-15