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Meta-Analysis
. 2018 Oct;48(2):198-204.
doi: 10.1016/j.semarthrit.2018.01.010. Epub 2018 Jan 31.

Pulmonary manifestations in late versus early systemic lupus erythematosus: A systematic review and meta-analysis

Jennifer L Medlin  1 , Karen E Hansen  2 , Sara S McCoy  2 , Christie M Bartels  3
Affiliations
Meta-Analysis

Pulmonary manifestations in late versus early systemic lupus erythematosus: A systematic review and meta-analysis

Jennifer L Medlin et al. Semin Arthritis Rheum. 2018 Oct.

Abstract

Objectives: Phenotypes differ between late- and early-onset systemic lupus erythematosus (SLE). Prior studies suggested that there may be more pulmonary disease among late-onset patients. Our objective was to perform a systematic review and meta-analysis to evaluate the differences in pulmonary manifestations in late- versus early-onset SLE.

Methods: We searched the literature using PubMed, CINAHL, Web of Science, Cochrane Library, and EMBASE. We excluded studies that did not include American College of Rheumatology SLE classification criteria, an early-onset SLE comparison group, or those that defined late-onset SLE as <50 years of age. We rated study quality using the Newcastle-Ottawa Quality Scale. We used Forest plots to compare odds ratios (95% confidence intervals) of pulmonary manifestations by age. Study heterogeneity was assessed using I2.

Results: Thirty-nine studies, representing 10,963 early-onset and 1656 late-onset patients with SLE, met eligibility criteria. The odds of developing several pulmonary manifestations were higher in the late-onset group. Interstitial lung disease (ILD) was nearly three times more common (OR = 2.56 (1.27, 5.16)). Pleuritis (OR = 1.53 (1.19, 1.96)) and serositis (OR = 1.31 (1.05, 1.65)) were also more common in the late-onset group. The mean Newcastle-Ottawa Quality Scale score for study quality was moderate (6.3 ± 0.7, scale 0-9).

Conclusions: Pulmonary manifestations of SLE were more common in late-onset SLE patients compared to their younger peers, in particular ILD and serositis. Age-related changes of the immune system, tobacco exposure, race, and possible overlap with Sjögren's syndrome should be examined in future studies.

Keywords: Interstitial lung disease (ILD); Pleuritis; Pulmonary manifestations; Serositis; Systemic lupus erythematosus (SLE).

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Conflict of interest statement

All other authors have no direct financial, consultant, or institutional conflict of interest pertaining to this manuscript.

Figures

Figure 1
Figure 1
Study selection process with description of study inclusion and exclusions during the three-level review for the systematic review and meta-analysis.
Figure 2
Figure 2
Odds of interstitial lung disease in late-onset versus early-onset systemic lupus erythematosus patients using a random effects model.
Figure 3
Figure 3
Odds of pleuritis in late-onset versus early-onset systemic lupus erythematosus patients using random effects model.
Figure 4
Figure 4
Odds of all pulmonary manifestations in late-onset versus early-onset systemic lupus erythematosus patients using random effects model.
See this image and copyright information in PMC

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