Pleuropulmonary manifestations in juvenile onset systemic lupus erythematosus: Assessment by pulmonary function tests and multidetector computed tomography

AbstractIntroductionPulmonary involvement is a common finding in adults with systemic lupus erythematosus (SLE) also it is one of the most important systems that can be affected in Juvenile onset SLE (JOSLE). Early detection and evaluation of the extent and severity of pulmonary involvement are quite critical for disease prognosis and patients management.Aim of the workTo determine the frequency and type of pleuropulmonary involvement in JOSLE using pulmonary function tests (PFTs) and multidetector CT (MDCT).Patients and methodsTwenty five patients with JOSLE were evaluated for the detection of pleuropulmonary affection in them. The evaluation included clinical, functional & radiological examination using MDCT as a recent & accurate modality for chest imaging. Based on clinical evaluation, patients were divided into two groups; group A (No=16) and group B (No=9), consisting of those asymptomatic and symptomatic as regard pleuropulmonary symptoms, respectively.ResultsThis study revealed that PFT abnormalities were detected in 60% of all studied JOSLE patients while MDCT abnormalities were detected in 52% of them. 37.5% of the asymptomatic patients had abnormal PFTs & 31.25% of them had abnormal findings on MDCT. There was statistically significant difference between patients groups regarding SLEDAI, percentages of abnormal PFTs, abnormalities in plain X-ray and MDCT. With the exception of forced expiratory flow at 25–75% of forced vital capacity (FEF25–75%), the study revealed statistically significant lower values of mean±SD of all measured PFTs in group B compared to group A. The most frequent MDCT findings in all studied patients were pleural effusion and pleural thickening in 16% of all findings, also ground glass opacities found in 16% of all abnormalities suggesting early interstitial lung disease.ConclusionClinical assessment and PFTs revealed a significant percentage of pleuropulmonary involvement in JOSLE patients. MDCT can be helpful in diagnosing the pulmonary involvement in asymptomatic JOSLE patients with normal chest X-ray and uncertain PFT

Anti-Saccharomyces cerevisiae antibodies and its relationship with radiological damage in ankylosing spondylitis

Aim The presence of anti-Saccharomyces cerevisiae antibodies (ASCA) is controversial in ankylosing spondylitis (AS). In this study, we aimed to investigate the prevalence of ASCA in AS and its relationship with disease activity and radiological damage in patients attending Sharkia governorate hospitals. Patients and methods Thirty AS patients and 30 apparently healthy volunteers were included in the present study. All patients were questioned for Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis metrology Index and Bath Ankylosing Functional Index (BASFI). Total Bath Ankylosing Spondylitis Radiology Index (BASRI-T) and ASCA levels were measured. Results ASCA IgA level was significantly higher in AS patients than in healthy controls (P < 0.001). The ASCA-positive group, although not significant, tended to have higher BASFI scores. ASCA IgA-positive patients had higher BASRI-T levels (P = 0.037). In AS patients, significant positive correlation was found between ASCA IgA level and BASRI-T and BASFI (r = 0.19 and 0.31, respectively, P < 0.05). Bath Ankylosing Spondylitis Disease Activity Index scores, BASFI and ASCA IgA positivity were significantly associated with increased BASRI-T (P= 0.01, 0.03 and 0.04, respectively). The most significant risk factor for increased BASRI-T is ASCA IgA positivity (P < 0.001). Conclusion ASCA IgA was detected more frequently in AS patients than in healthy controls. ASCA IgA could be considered a marker of severe radiological damage. Further studies are recommended to investigate ASCA level versus radiological damage and intestinal involvement in AS patients