Systemic Lupus Erythematosus and Lung Involvement: A Comprehensive Review

Abstract

Systemic lupus erythematosus (SLE) is a complex autoimmune disease with multiorgan manifestations, including pleuropulmonary involvement (20-90%). The precise mechanism of pleuropulmonary involvement in SLE is not well-understood; however, systemic type 1 interferons, circulating immune complexes, and neutrophils seem to play essential roles. There are eight types of pleuropulmonary involvement: lupus pleuritis, pleural effusion, acute lupus pneumonitis, shrinking lung syndrome, interstitial lung disease, diffuse alveolar hemorrhage (DAH), pulmonary arterial hypertension, and pulmonary embolism. DAH has a high mortality rate (68-75%). The diagnostic tools for pleuropulmonary involvement in SLE include chest X-ray (CXR), computed tomography (CT), pulmonary function tests (PFT), bronchoalveolar lavage, biopsy, technetium-99m hexamethylprophylene amine oxime perfusion scan, and (18)F-fluorodeoxyglucose positron emission tomography. An approach for detecting pleuropulmonary involvement in SLE includes high-resolution CT, CXR, and PFT. Little is known about specific therapies for pleuropulmonary involvement in SLE. However, immunosuppressive therapies such as corticosteroids and cyclophosphamide are generally used. Rituximab has also been successfully used in three of the eight pleuropulmonary involvement forms: lupus pleuritis, acute lupus pneumonitis, and shrinking lung syndrome. Pleuropulmonary manifestations are part of the clinical criteria for SLE diagnosis. However, no review article has focused on the involvement of pleuropulmonary disease in SLE. Therefore, this article summarizes the literature on the epidemiology, pathogenesis, diagnosis, and management of pleuropulmonary involvement in SLE.

Keywords: autoimmunity; lung; pleuropulmonary; review; systemic lupus erythematosus.

Figure 1

Pathogenesis of lung involvement in SLE [50,51,59,60].

Figure 2

HRCT scans of the SLE patients with pulmonary involvement. Arrow indicate the shape of lung lesion of HRCT (A) Fibrotic streak. (B) Reticular pattern. (C) Mosaic perfusion. (D) Pleural thickening. (E) Ground glass opacity. (F) Subpleural interlobular septal thickening (The CC-BY Creative Commons attribution license, Dai G, Li L, Wang T, Jiang W, Ma J, Yan Y, Chen Z. Pulmonary Involvement in Children With Systemic Lupus Erythematosus. Front Pediatr. 2021 Feb 2; 8:617137. doi: 10.3389/fped.2020.617137. PMID: 33604317; PMCID: PMC7884320) [69].