Pulmonary hemorrhage in systemic lupus erythematosus
Section snippets
Patient selection
Tan Tock Seng Hospital is a tertiary referral center for rheumatology in Singapore where 200 to 300 patients with SLE are admitted each year. The lupus cohort here has 1500 patients on follow-up. From our lupus database and from a search of in-patient medical records, we obtained the names of SLE patients admitted with PH from 1994 to 2002. A total of 23 names were obtained, but 1 patient was excluded because she did not have PH. All patients fulfilled the American College of Rheumatology (ACR)
Patient characteristics
PH in our group of SLE patients occurred in young patients (mean age, 31.6 ± 12.3 years) early in the course of disease (median duration of SLE was 0.96 years; IQR, 0 to 7 years) Table 1, Table 2, Table 3. Seven (32%) patients presented with PH as 1 of their disease manifestations at the onset of SLE and 55% had PH within the first year of SLE diagnosis. The patients were mostly female (91%) and Chinese (68%) other races were Malay (14%), Indian (9%), and Eurasian (9%).
Disease activity
At the time of PH,
Discussion
To our knowledge, this is the largest collection of SLE patients with PH reported. Our patients were young, with active SLE and multi-organ involvement.
Humeira Badsha, MD: Consultant, Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
References (22)
- et al.
Pulmonary alveolar hemorrhage in systemic lupus erythematosus
Semin Arthritis Rheum
(1993) - et al.
Alveolar haemorrhage in systemic lupus erythematosusPresentation and management
Chest
(2000) - et al.
Isolated pulmonary capillaritis and diffuse alveolar haemorrhage in rheumatoid arthritis and mixed connective tissue disease
Chest
(1998) - et al.
Fatal pulmonary haemorrhage in systemic lupus erythematosus. Occurrence without haemoptysis
J Rheumatol
(1985) - et al.
Pulmonary haemorrhage in systemic lupus erythematosus
Lupus
(1997) - et al.
Derivation of the SLEDAI. A disease activity index for lupus patients
Arthritis Rheum
(1992) - et al.
Reliability and validity of six systems for the clinical assessment of disease activity in systemic lupus erythematosus
Arthritis Rheum
(1989) - et al.
The 1982 revised criteria for the classification of systemic lupus erythematosus
Arthritis Rheum
(1992) - et al.
Diffuse alveolar hemorrhage and systemic lupus erythematosus. Clinical presentation, histology, survival, and outcome
Medicine (Baltimore)
(1997) - et al.
CT appearance of diffuse alveolar hemorrhage in a patient with systemic lupus erythematosus
Acta Radiol
(1993)
Pulmonary haemorrhage complicating systemic lupus erythematosusrole of MR imaging in diagnosis
AJR Am J Roentgenol
Cited by (111)
Systemic lupus erythematosus in pediatric patients: Pulmonary manifestations
2023, Respiratory MedicineThe Role of MRI in Differentiating Demyelinating and Inflammatory (not Infectious) Myelopathies
2023, Seminars in Ultrasound, CT and MRIeNAMPT/TLR4 inflammatory cascade activation is a key contributor to SLE Lung vasculitis and alveolar hemorrhage
2023, Journal of Translational AutoimmunityDiffuse Alveolar Haemorrhage in Systemic Lupus Erythematosus Patients
2022, Reumatologia ClinicaImmunosuppressive therapy in SLE
2021, Lahita’s Systemic Lupus ErythematosusAlveolar haemorrhage in ANCA-associated vasculitis: Long-term outcome and mortality predictors
2020, Journal of AutoimmunityCitation Excerpt :Bronchoscopy was also helpful in making diagnosis (sensitivity of 98.4%) showing a progressively bloody BAL fluid in 56.4% of cases. Interestingly, spirometry was performed in few patients, none of them showing an increase in DLCO, differently from some observations reported in other series where an increase of DLCO was helpful for supporting the diagnosis of AH in lupus patients [40,41]. Thus, spirometry does not seem to be a useful tool both for diagnosis and follow-up in AAV-AH.
Humeira Badsha, MD: Consultant, Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
Cheng Lay Teh, MD, MRCP: Registrar, Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
Kok Ooi Kong, MBBS, MRCP: Registrar, Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
Tsui Yee Lian, MBBS, MRCP: Associate Consultant, Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
Hiok Hee Chng, MMed (Int Med), FRCP (Glas), FAMS: Senior Consultant and Head, Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore.