Abstract
BACKGROUND: In systemic lupus erythematosus, certain laboratory tests and evidence from muscle biopsy specimens of lymphocytic vasculitis reflect disease activity. A study was designed to determine if such indices predict respiratory lesions, and in particular whether the presence of vasculitis in quadriceps muscle reflects respiratory muscle function. METHODS: Twenty seven 27 patients with systemic lupus erythematosus were studied, ten of whom were consecutive untreated patients and 17 having clinically active disease and being treated. They were prospectively evaluated on the basis of erythrocyte sedimentation rate, lymphocyte count, C3 degradation products, quadriceps muscle biopsy, spirometry, lung volumes, carbon monoxide transfer factor, and mouth pressure during a maximal sniff. RESULTS: Lung function test results were abnormal in 12 patients. Vital capacity was reduced in seven, carbon monoxide transfer factor capacity in five, and mouth pressure was low (< 70% predicted) in ten. Lymphocytic vasculitis was seen in the muscle biopsy specimens of ten patients. No correlation was found between laboratory tests and lung function or mouth pressure, or between the presence of lymphocytic vasculitis and mouth pressure. In untreated patients, those with lymphocytic vasculitis had lower spirometric values. CONCLUSIONS: In systemic lupus erythematosus, evidence from muscle biopsy specimens of lymphocytic vasculitis is not predictive of impaired inspiratory muscle function as measured by mouth pressure. In untreated patients there were relationships between some laboratory test results and respiratory function, but this was not the case for the whole group. In systemic lupus erythematosus, laboratory tests and evidence from muscle biopsy specimens of lymphocytic vasculitis are therefore unlikely to be helpful in the assessment of respiratory disease.
Full text
PDFImages in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- ALARCON-SEGOVIA D., ALARCON D. G. Pleuro-pulmonary manifestations of systemic lupus erythematosus. Dis Chest. 1961 Jan;39:7–17. doi: 10.1378/chest.39.1.7. [DOI] [PubMed] [Google Scholar]
- Andonopoulos A. P., Constantopoulos S. H., Galanopoulou V., Drosos A. A., Acritidis N. C., Moutsopoulos H. M. Pulmonary function of nonsmoking patients with systemic lupus erythematosus. Chest. 1988 Aug;94(2):312–315. doi: 10.1378/chest.94.2.312. [DOI] [PubMed] [Google Scholar]
- Brandslund I., Siersted H. C., Svehag S. E., Teisner B. Double-decker rocket immunoelectrophoresis for direct quantitation of complement C3 split products with C3d specificities in plasma. J Immunol Methods. 1981;44(1):63–71. doi: 10.1016/0022-1759(81)90107-1. [DOI] [PubMed] [Google Scholar]
- Dubois E. L., Wierzchowiecki M., Cox M. B., Weiner J. M. Duration and death in systemic lupus erythematosus. An analysis of 249 cases. JAMA. 1974 Mar 25;227(12):1399–1402. [PubMed] [Google Scholar]
- Estes D., Christian C. L. The natural history of systemic lupus erythematosus by prospective analysis. Medicine (Baltimore) 1971 Mar;50(2):85–95. doi: 10.1097/00005792-197103000-00001. [DOI] [PubMed] [Google Scholar]
- Gibson C. J., Edmonds J. P., Hughes G. R. Diaphragm function and lung involvement in systemic lupus erythematosus. Am J Med. 1977 Dec;63(6):926–932. doi: 10.1016/0002-9343(77)90547-2. [DOI] [PubMed] [Google Scholar]
- Grennan D. M., Howie A. D., Moran F., Buchanan W. W. Pulmonary involvement in systemic lupus erythematosus. Ann Rheum Dis. 1978 Dec;37(6):536–539. doi: 10.1136/ard.37.6.536. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Grigor R., Edmonds J., Lewkonia R., Bresnihan B., Hughes G. R. Systemic lupus erythematosus. A prospective analysis. Ann Rheum Dis. 1978 Apr;37(2):121–128. doi: 10.1136/ard.37.2.121. [DOI] [PMC free article] [PubMed] [Google Scholar]
- HOFFBRAND B. I., BECK E. R. "UNEXPLAINED" DYSPNOEA AND SHRINKING LUNGS IN SYSTEMIC LUPUS ERYTHEMATOSUS. Br Med J. 1965 May 15;1(5445):1273–1277. doi: 10.1136/bmj.1.5445.1273. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hecht B., Siegel N., Adler M., Kashgarian M., Hayslett J. P. Prognostic indices in lupus nephritis. Medicine (Baltimore) 1976 Mar;55(2):163–181. doi: 10.1097/00005792-197603000-00005. [DOI] [PubMed] [Google Scholar]
- Kelly C. A., Foster H., Pal B., Gardiner P., Malcolm A. J., Charles P., Blair G. S., Howe J., Dick W. C., Griffiths I. D. Primary Sjögren's syndrome in north east England--a longitudinal study. Br J Rheumatol. 1991 Dec;30(6):437–442. doi: 10.1093/rheumatology/30.6.437. [DOI] [PubMed] [Google Scholar]
- Koulouris N., Mulvey D. A., Laroche C. M., Sawicka E. H., Green M., Moxham J. The measurement of inspiratory muscle strength by sniff esophageal, nasopharyngeal, and mouth pressures. Am Rev Respir Dis. 1989 Mar;139(3):641–646. doi: 10.1164/ajrccm/139.3.641. [DOI] [PubMed] [Google Scholar]
- Laroche C. M., Mier A. K., Moxham J., Green M. The value of sniff esophageal pressures in the assessment of global inspiratory muscle strength. Am Rev Respir Dis. 1988 Sep;138(3):598–603. doi: 10.1164/ajrccm/138.3.598. [DOI] [PubMed] [Google Scholar]
- Laroche C. M., Mulvey D. A., Hawkins P. N., Walport M. J., Strickland B., Moxham J., Green M. Diaphragm strength in the shrinking lung syndrome of systemic lupus erythematosus. Q J Med. 1989 May;71(265):429–439. [PubMed] [Google Scholar]
- Levinsky R. J., Cameron J. S., Soothill J. F. Serum immune complexes and disease activity in lupus nephritis. Lancet. 1977 Mar 12;1(8011):564–567. doi: 10.1016/s0140-6736(77)91998-5. [DOI] [PubMed] [Google Scholar]
- Lloyd W., Schur P. H. Immune complexes, complement, and anti-DNA in exacerbations of systemic lupus erythematosus (SLE). Medicine (Baltimore) 1981 May;60(3):208–217. doi: 10.1097/00005792-198105000-00004. [DOI] [PubMed] [Google Scholar]
- Martens J., Demedts M., Vanmeenen M. T., Dequeker J. Respiratory muscle dysfunction in systemic lupus erythematosus. Chest. 1983 Aug;84(2):170–175. doi: 10.1378/chest.84.2.170. [DOI] [PubMed] [Google Scholar]
- Miller J. M., Moxham J., Green M. The maximal sniff in the assessment of diaphragm function in man. Clin Sci (Lond) 1985 Jul;69(1):91–96. doi: 10.1042/cs0690091. [DOI] [PubMed] [Google Scholar]
- Morrow W. J., Williams D. J., Ferec C., Casburn-Budd R., Isenberg D. A., Paice E., Snaith M. L., Youinou P., Le Goff P. The use of C3d as a means of monitoring clinical activity in systemic lupus erythematosus and rheumatoid arthritis. Ann Rheum Dis. 1983 Dec;42(6):668–671. doi: 10.1136/ard.42.6.668. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pussell B. A., Lockwood C. M., Scott D. M., Pinching A. J., Peters D. K. Value of immune-complex assays in diagnosis and management. Lancet. 1978 Aug 12;2(8085):359–364. doi: 10.1016/s0140-6736(78)92954-9. [DOI] [PubMed] [Google Scholar]
- Rivero S. J., Díaz-Jouanen E., Alarcón-Segovia D. Lymphopenia in systemic lupus erythematosus. Clinical, diagnostic, and prognostic significance. Arthritis Rheum. 1978 Apr;21(3):295–305. doi: 10.1002/art.1780210302. [DOI] [PubMed] [Google Scholar]
- Silberstein S. L., Barland P., Grayzel A. I., Koerner S. K. Pulmonary dysfunction in systemic lupus erythematosus:prevalence classification and correlation with other organ involvement. J Rheumatol. 1980 Mar-Apr;7(2):187–195. [PubMed] [Google Scholar]
- Tan E. M., Cohen A. S., Fries J. F., Masi A. T., McShane D. J., Rothfield N. F., Schaller J. G., Talal N., Winchester R. J. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1982 Nov;25(11):1271–1277. doi: 10.1002/art.1780251101. [DOI] [PubMed] [Google Scholar]
- Wasicek C. A., Reichlin M. Clinical and serological differences between systemic lupus erythematosus patients with antibodies to Ro versus patients with antibodies to Ro and La. J Clin Invest. 1982 Apr;69(4):835–843. doi: 10.1172/JCI110523. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wilcox P. G., Stein H. B., Clarke S. D., Paré P. D., Pardy R. L. Phrenic nerve function in patients with diaphragmatic weakness and systemic lupus erythematosus. Chest. 1988 Feb;93(2):352–358. doi: 10.1378/chest.93.2.352. [DOI] [PubMed] [Google Scholar]
- Winfield J. B., Brunner C. M., Koffler D. Serologic studies in patients with systemic lupus erythematosus and central nervous system dysfunction. Arthritis Rheum. 1978 Apr;21(3):289–294. doi: 10.1002/art.1780210301. [DOI] [PubMed] [Google Scholar]
- Worth H., Grahn S., Lakomek H. J., Bremer G., Goeckenjan G. Lung function disturbances versus respiratory muscle fatigue in patients with systemic lupus erythematosus. Respiration. 1988;53(2):81–90. doi: 10.1159/000195401. [DOI] [PubMed] [Google Scholar]