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Byrne L, McCarthy C, Fabre A, Gupta N. Pulmonary Manifestations of Sjögren's Disease. Semin Respir Crit Care Med 2024; 45:397-410. [PMID: 38621712 DOI: 10.1055/s-0044-1785675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Sjögren's disease (SjD) is a chronic, progressive autoimmune condition of exocrine and extraglandular tissues. It can present with isolated disease characterized by lymphocytic infiltration of salivary or lacrimal glands, but in approximately one-third of the patients, lymphocytic infiltration extends beyond exocrine glands to involve extraglandular organs such as the lungs. Pulmonary complications have been reported to occur between 9 and 27% of patients with SjD across studies. Respiratory manifestations occur on a spectrum of severity and include airways disease, interstitial lung disease, cystic lung disease, and lymphoma. Lung involvement can greatly affect patients' quality of life, has a major impact on the overall prognosis, and frequently leads to alteration in the treatment plans, highlighting the importance of maintaining a high index of clinical suspicion and taking appropriate steps to facilitate early recognition and intervention.
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Affiliation(s)
- Louise Byrne
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Aurelie Fabre
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Histopathology, St. Vincent's University Hospital, Dublin, Ireland
| | - Nishant Gupta
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, Cincinnati, Ohio
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Chawla RK, Chawla AK, Chaudhary G, Chawla MK, Sareen M. Sjogren's syndrome-An interesting case. Indian J Tuberc 2022; 69:109-112. [PMID: 35074142 DOI: 10.1016/j.ijtb.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/03/2020] [Accepted: 12/07/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To present a case of Sjogren syndrome with pulmonary manifestations in an adult female and discuss its assessment and management. DESIGN Case Report. SETTING Tertiary care hospital. PATIENT One. RESULTS A 50 yrs female admitted with complaints of dryness of eyes with decreased salivation causing difficulty in swallowing since last 3 years, with persistent dry cough since 10-15 days and progressive dyspnea since 4-5 days. Anti-nuclear antibody (ANA) profile revealed Anti- Ro/SS-A and Anti- La/SS-B Positive. Also, sub-lingual excisional biopsy was done which was consistent with findings of Sjogren's syndrome. Patient showed significant improvement after starting oral glucocorticoids, systemic anti inflammatory agents (Tab. HCQS), artificial tear drops, oral iron supplements and other supportive treatment. CONCLUSION Sjögren syndrome (SS) is a chronic inflammatory disorder characterized by diminished lacrimal and salivary gland function and associated with lymphocytic infiltration of exocrine glands, and can affect extraglandular organ systems including the skin, lung, heart, kidney, neural, and hematopoietic systems. We present a case of Sjogren syndrome in an adult female presenting with xerostomia and dyspnea and was diagnosed upon detection of anti-Ro and anti-La antibodies and confirmed by histopathological examination of lip biopsy. Patient was started on oral steroids and other supportive treatment, General condition improved significantly and is doing very well on regular follow-up.
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Affiliation(s)
- Rakesh K Chawla
- Department of Pulmonary Medicine, Critical Care and Sleep disorders, Jaipur Golden Hospital, Saroj Super Speciality Hospital, 36, Pocket: E-3, Sector-3, Rohini, New Delhi, 110085, India.
| | - Aditya K Chawla
- Department of Pulmonary Medicine, Critical Care and Sleep disorders, Jaipur Golden Hospital, Saroj Super Speciality Hospital, 36, Pocket: E-3, Sector-3, Rohini, New Delhi, 110085, India
| | - Gaurav Chaudhary
- Department of Pulmonary Medicine, Critical Care and Sleep disorders, Jaipur Golden Hospital, Saroj Super Speciality Hospital, 36, Pocket: E-3, Sector-3, Rohini, New Delhi, 110085, India
| | - Madhav K Chawla
- Department of Pulmonary Medicine, Critical Care and Sleep disorders, Jaipur Golden Hospital, Saroj Super Speciality Hospital, 36, Pocket: E-3, Sector-3, Rohini, New Delhi, 110085, India
| | - Manoj Sareen
- Department of Pulmonary Medicine, Critical Care and Sleep disorders, Jaipur Golden Hospital, Saroj Super Speciality Hospital, 36, Pocket: E-3, Sector-3, Rohini, New Delhi, 110085, India
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3
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Cottin V, Lega JC, Coury F, Nasser M. A call for evidence in connective tissue diseases-associated interstitial lung disease. Joint Bone Spine 2021; 89:105274. [PMID: 34536627 DOI: 10.1016/j.jbspin.2021.105274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Vincent Cottin
- National Reference Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, IVPC, INRAE, Claude Bernard University Lyon 1, member of ERN-LUNG, 28, avenue Doyen Lepine, 69677 Lyon cedex, France.
| | - Jean-Christophe Lega
- University of Lyon, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, CNRS, 69100 Villeurbanne, France; Department of Internal and Vascular Medicine, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Fabienne Coury
- Inserm UMR1033 LYOS, University of Lyon I, 69003 Lyon, France; Department of Rheumatology, Lyon Sud Hospital, 69310 Pierre-Bénite, France
| | - Mouhamad Nasser
- National Reference Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, IVPC, INRAE, Claude Bernard University Lyon 1, member of ERN-LUNG, 28, avenue Doyen Lepine, 69677 Lyon cedex, France
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Lee S, Lee JH. Current advances in the treatment of autoimmune-associated interstitial lung diseases. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.4.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Autoimmune-associated interstitial lung disease (ILD) is a widespread and clinically significant form of autoimmune diseases. ILD can be present in most type of autoimmune diseases. Scleroderma, Sjogren syndrome, rheumatoid arthritis, inflammatory myositis, systemic lupus erythematosus, and mixed connective tissue disease are all examples of autoimmune disorders that can cause ILD. Treatment and prognosis vary from that of other forms of ILD depending on the etiology and pathogenesis of the autoimmune disease. As a result, glucocorticoids and immunosuppressive agents are the mainstays of treatment for autoimmune-associated ILD, despite the fact that there is little high-level evidence to guide the treatment owing to limited data from randomized controlled trials. Immunosuppressive agents including cyclophosphamide, tacrolimus, azathioprine, and mycophenolate mofetil can be used to reduce the dose of glucocorticoids and the inflammatory cascade and inhibit various pro-inflammatory cytokines. Studies have also started alternative therapeutic approaches, such as biological and antifibrotic agents, and traditional immunosuppressive agents. In this review, we summarize available treatment options and recent advances in therapeutic strategies for patients with autoimmune-associated ILD.
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Nucera V, Gerratana E, Giallanza M, La Corte L, Sangari D, Atzeni F. Efficacy of cyclophosphamide in treating connective tissue disease-related interstitial lung diseases. Drugs Context 2021; 10:dic-2020-9-1. [PMID: 33505481 PMCID: PMC7813436 DOI: 10.7573/dic.2020-9-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/14/2020] [Indexed: 11/24/2022] Open
Abstract
Interstitial lung diseases (ILDs) are some of the first and most serious complications of connective tissue diseases (CTDs). However, the pathogenesis of CTD-related ILDs (CTD-ILDs) is still unclear and their treatment often depends on functional and radiographic disease progression as well as on patient age and comorbidities. It can be difficult to manage CTD-ILDs due to their heterogeneous nature, the lack of robust therapeutic data, and the few well-defined outcome measures. This review focuses on cyclophosphamide due to its crucial role in the treatment of systemic sclerosis-related ILD, particularly in the case of patients with progressive ILD. This narrative review was performed using PubMed, Medline, and Cochrane Library databases to retrieve English language papers published between 2000 and April 2020 concerning the treatment of CTD-ILDs with cyclophosphamide.
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Affiliation(s)
- Valeria Nucera
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy
| | - Elisabetta Gerratana
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy
| | - Manuela Giallanza
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy
| | - Laura La Corte
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy
| | - Donatella Sangari
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy
| | - Fabiola Atzeni
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy
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Ramphul M, Gallagher K, Warrier K, Jagani S, Bhatt JM. Why is a paediatric respiratory specialist integral to the paediatric rheumatology clinic? Breathe (Sheff) 2020; 16:200212. [PMID: 33447294 PMCID: PMC7792836 DOI: 10.1183/20734735.0212-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/01/2020] [Indexed: 12/20/2022] Open
Abstract
Systemic connective tissue diseases (CTDs) are characterised by the presence of autoantibodies and multiorgan involvement. Although CTDs are rare in children, they are associated with pulmonary complications, which have a high morbidity and mortality rate. The exact pathophysiology remains unclear. The pleuropulmonary complications in CTD are diverse in their manifestations and are often complex to diagnose and manage. The most common CTDs are discussed. These include juvenile systemic lupus erythematosus, juvenile dermatomyositis, juvenile systemic sclerosis, Sjögren's syndrome and mixed connective tissue disease. We describe the clinical features of the pleuropulmonary complications, focusing on their screening, diagnosis and monitoring. Treatment strategies are also discussed, highlighting the factors and interventions that influence the outcome of lung disease in CTD and pulmonary complications of treatment. Early detection and prompt treatment in a multidisciplinary team setting, including respiratory and rheumatology paediatricians and radiologists, is paramount in achieving the best possible outcomes for these patients.
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Affiliation(s)
- Manisha Ramphul
- Dept of Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals, Nottingham, UK
| | - Kathy Gallagher
- Dept of Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals, Nottingham, UK
| | - Kishore Warrier
- Dept of Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals, Nottingham, UK
| | - Sumit Jagani
- Dept of Radiology, Nottingham University Hospitals, Nottingham, UK
| | - Jayesh Mahendra Bhatt
- Dept of Paediatric Respiratory Medicine, Nottingham Children's Hospital, Nottingham University Hospitals, Nottingham, UK
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Luppi F, Sebastiani M, Sverzellati N, Cavazza A, Salvarani C, Manfredi A. Lung complications of Sjogren syndrome. Eur Respir Rev 2020; 29:29/157/200021. [PMID: 32817113 PMCID: PMC9489025 DOI: 10.1183/16000617.0021-2020] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/20/2020] [Indexed: 12/14/2022] Open
Abstract
Primary Sjogren syndrome (pSS) is a systemic autoimmune disease characterised by lymphocytic infiltration of exocrine glands and by a number of systemic manifestations, including those regarding the lung. Pulmonary involvement in pSS includes interstitial lung disease (ILD) and airway disease, together with lymphoproliferative disorders. Patients with pSS-ILD report impaired health-related quality of life and a higher risk of death, suggesting the importance of early diagnosis and treatment of this type of pulmonary involvement. In contrast, airway disease usually has little effect on respiratory function and is rarely the cause of death in these patients. More rare disorders can be also identified, such as pleural effusion, cysts or bullae. Up to date, available data do not allow us to establish an evidence-based treatment strategy in pSS-ILD. No data are available regarding which patients should be treated, the timing to start therapy and better therapeutic options. The lack of knowledge about the natural history and prognosis of pSS-ILD is the main limitation to the development of clinical trials or shared recommendations on this topic. However, a recent trial showed the efficacy of the antifibrotic drug nintedanib in slowing progression of various ILDs, including those in pSS patients. Primary Sjogren syndrome is a systemic autoimmune disease with a possible lung involvement, that it appears as polymorphic, including interstitial lung disease, airway disease and lymphoproliferative disorders with different degree of severityhttps://bit.ly/3akjk4b
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Affiliation(s)
- Fabrizio Luppi
- Dept of Medicine and Surgery, University of Milan Bicocca, Milan, Italy .,Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Marco Sebastiani
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero- Universitaria Policlinico di Modena, Modena, Italy
| | - Nicola Sverzellati
- Section of Radiology, Unit of Surgical Sciences, Dept of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Alberto Cavazza
- Pathology Unit, AUSL/IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Salvarani
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero- Universitaria Policlinico di Modena, Modena, Italy
| | - Andreina Manfredi
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero- Universitaria Policlinico di Modena, Modena, Italy
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8
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Connective Tissue Disease-Related Interstitial Lung Disease: Prevalence, Patterns, Predictors, Prognosis, and Treatment. Lung 2020; 198:735-759. [DOI: 10.1007/s00408-020-00383-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/26/2020] [Indexed: 12/13/2022]
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9
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Ng KH, Chen DY, Lin CH, Chao WC, Chen YM, Chen YH, Huang WN, Hsieh TY, Lai KL, Tang KT, Chen HH. Risk of interstitial lung disease in patients with newly diagnosed systemic autoimmune rheumatic disease: A nationwide, population-based cohort study. Semin Arthritis Rheum 2020; 50:840-845. [PMID: 32896697 DOI: 10.1016/j.semarthrit.2020.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/09/2020] [Accepted: 07/20/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To assess interstitial lung disease (ILD) risk among patients newly diagnosed with systemic autoimmune rheumatic diseases (SARDs) including rheumatoid arthritis (RA), dermatomyositis (DMtis), polymyositis (PM), systemic sclerosis (SSc), systemic lupus erythematosus (SLE) and primary Sjögren's syndrome (pSS). METHOD Using the 1997-2013 Taiwanese National Health Insurance Research Database, we identified 62,930 newly diagnosed SARD patients from 2001 to 2013. We selected 251,720 individuals without SARD diagnoses who were matched (1:4) with SARD patients by age, sex and year of index date. We compared the incidence rates (IRs) of ILD (consistent diagnosis with ICD-9 code 515, 516.3, 516.8, 516.9 or 517 after a ILD-related radiological or pathological procedure) between the specific SARD subgroups and the corresponding non-SARD comparison groups. Using multivariable Cox regression analyses, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) of ILD in the various SARD groups compared with comparison groups after adjusting for age, sex and Charlson comorbidity index. RESULTS The IR of ILD was greatest among patients with SSc (1,364 per 105 years), followed by DMtis (1,011 per 105 years), PM (831 per 105 years), pSS (196 per 105 years), RA (109 per 105 years) and SLE (120 per 105 years). Multivariable analyses showed that the risk of ILD was increased among patients with SSc (HR, 172.63), DMtis (HR, 119.61), PM (HR, 84.89), SLE (HR, 32.18), pSS (HR, 17.54), or RA (HR, 8.29). CONCLUSION This population-based, cohort study demonstrates that the risk of ILD is significantly increased in patients with newly diagnosed SARDs.
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Affiliation(s)
- Kooi-Heng Ng
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan
| | - Der-Yuan Chen
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung 40447, Taiwan; Translational Medicine Laboratory, Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan; Department of Healthcare Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Wen-Cheng Chao
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Business Administration, National Changhua University of Education, Changhua, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Ming Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, National Chung-Hsing University, Taichung, Taiwan
| | - Yi-Hsing Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Nan Huang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tsu-Yi Hsieh
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan; Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan; Program of Business, Feng Chia University, Taichung, Taiwan
| | - Kuo-Lung Lai
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Kuo-Tung Tang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan
| | - Hsin-Hua Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan; Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, National Chung-Hsing University, Taichung, Taiwan.
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Amlani B, Elsayed G, Barvalia U, Kanne JP, Meyer KC, Sandbo N, Li Z, McCoy SS. Treatment of primary sjögren's syndrome-related interstitial lung disease: a retrospective cohort study. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2020; 37:136-147. [PMID: 33093777 PMCID: PMC7569546 DOI: 10.36141/svdld.v37i2.8461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/12/2020] [Indexed: 12/04/2022]
Abstract
Background: Interstitial lung disease (ILD) is a common complication of primary Sjögren’s syndrome (pSS). Because there is a paucity of literature on the management of pSS-associated ILD (pSS-ILD), this retrospective cohort study assessed the efficacy of azathioprine and mycophenolate therapy in adult patients with pSS-ILD. Methods: A retrospective cohort study was performed using electronic health records to identify adults meeting the 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for pSS. The presence of pSS-ILD was confirmed by characteristic high-resolution computed tomography and/or histopathology findings. Sociodemographic, clinical, and pulmonary function test (PFT) data were abstracted for patients meeting the criteria and followed longitudinally from the date of their ILD diagnosis. PFT values were anchored on time of treatment start, and linear mixed-effects modeling was used to analyze changes in diffusion capacity for carbon monoxide (DLCO) and forced vital capacity (FVC) before and after treatment initiation. Results: We identified 19 subjects who had pSS-ILD, of whom seven were treated with azathioprine and seven were treated with mycophenolate. Within the azathioprine treated group, FVC% slope change trended toward improvement from a rate of -9.8% per month pre-treatment to 2.1% per month post-treatment (p = 0.13). Within the mycophenolate treated group, FVC% slope change improved from a rate of 1.5% per month pre-treatment to 4.3% per month post-treatment (p = 0.02) and DLCO% slope changed from a rate of -3.8% to –1.3% per month (p = 0.01) after therapy start. Conclusions: Mycophenolate treatment was associated with significant improvement in PFTs of pSS-ILD patients over time, and azathioprine treatment followed a similar non-significanttrend. Additional prospective studies are needed to further evaluate these findings. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 136-147)
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Affiliation(s)
- Barkha Amlani
- Division of Rheumatology, Department of Internal Medicine Santa Clara Valley Medical Center, San Jose, CA
| | | | - Umang Barvalia
- Division of Pulmonary & Critical Care, Department of Internal Medicine, Santa Clara Valley Medical Center, San Jose, CA
| | - Jeffrey P Kanne
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Keith C Meyer
- Division of Pulmonary & Critical Care, Department of Internal Medicine, University of Wisconsin School of Public Health, Madison, WI, 53705, U.S.A
| | - Nathan Sandbo
- Division of Pulmonary & Critical Care, Department of Internal Medicine, University of Wisconsin School of Public Health, Madison, WI, 53705, U.S.A
| | - Zhanhai Li
- Department of Biostatistics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sara S McCoy
- Division of Rheumatology, Department of Internal Medicine, University of Wisconsin School of Public Health, Madison, WI
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Buvry C, Cassagnes L, Tekath M, Artigues M, Pereira B, Rieu V, Le Guenno G, Tournadre A, Ruivard M, Grobost V. Anti-Ro52 antibodies are a risk factor for interstitial lung disease in primary Sjögren syndrome. Respir Med 2020; 163:105895. [DOI: 10.1016/j.rmed.2020.105895] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 12/16/2019] [Accepted: 02/05/2020] [Indexed: 01/22/2023]
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12
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Gao Y, Moua T. Treatment of the Connective Tissue Disease-Related Interstitial Lung Diseases: A Narrative Review. Mayo Clin Proc 2020; 95:554-573. [PMID: 32138882 DOI: 10.1016/j.mayocp.2019.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/27/2019] [Accepted: 07/16/2019] [Indexed: 11/20/2022]
Abstract
Interstitial lung disease (ILD) is a frequent complication of patients with connective tissue disease (CTD) and significantly affects morbidity and mortality. Disease course may vary from stable or mildly progressive to more severe, with rapid loss of lung function. We conducted a search of PubMed (National Library of Medicine) and the Web of Science Core Collection using the key words lung, pulmonary, pneumonia, pneumonitis, and alveolar and subtypes of CTD. All clinical studies from January 1, 1980, through September 1, 2018, were reviewed for descriptions of specific therapies and their efficacy or safety and were categorized as controlled interventional trials, observational prospective or retrospective cohort studies, case series (>5 patients), and case reports (<5 patients). Low-quality reports (<5 patients) before 2000, reviews, editorials, popular science papers, and letters to the editor without complete descriptions of the therapies used or their outcomes were excluded. Directed therapy for CTD-ILD is dominated by empirical use of immunosuppressive agents, with the decision to treat, treatment choice, and treatment duration limited to cases and cohort observations. Only a few higher-level controlled studies were available specifically in scleroderma-related ILD. We summarize herein for the clinician the published treatment scope and experience, highlighted clinical response, and common adverse reactions for the management of CTD-ILD.
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Affiliation(s)
- Yang Gao
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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PRİMER SJÖGREN SENDROMUNDA SEROLOJİK TETKİKLERİN TÜKRÜK BEZİ BİYOPSİ DERECESİ VE KLİNİK İLİŞKİSİNİN DEĞERLENDİRİLMESİ. JOURNAL OF CONTEMPORARY MEDICINE 2019. [DOI: 10.16899/jcm.578199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Sjögren syndrome (SS) is a progressive autoimmune disease characterized by dryness, predominantly of the eyes and mouth, caused by chronic lymphocytic infiltration of the lacrimal and salivary glands. Extraglandular inflammation can lead to systemic manifestations, many of which involve the lungs. Studies in which lung involvement is defined as requiring the presence of respiratory symptoms and either radiograph or pulmonary function test abnormalities quote prevalence estimates of 9% to 22%. The most common lung diseases that occur in relation to SS are airways disease and interstitial lung disease. Evidence-based guidelines to inform treatment recommendations for lung involvement are largely lacking.
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Affiliation(s)
- Jake G Natalini
- Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 836 W. Gates Building, Philadelphia, PA 19104, USA
| | - Chadwick Johr
- Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, 3737 Market Street, 8th floor, Philadelphia, PA 19104, USA
| | - Maryl Kreider
- Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 836 W. Gates Building, Philadelphia, PA 19104, USA.
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15
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Gupta S, Ferrada MA, Hasni SA. Pulmonary Manifestations of Primary Sjögren's Syndrome: Underlying Immunological Mechanisms, Clinical Presentation, and Management. Front Immunol 2019; 10:1327. [PMID: 31249572 PMCID: PMC6583234 DOI: 10.3389/fimmu.2019.01327] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 05/24/2019] [Indexed: 01/08/2023] Open
Abstract
Pulmonary involvement in primary Sjögren's syndrome (pSS) is an understudied entity with important clinical implications. Its prevalence has been reported in up to 20% of pSS patients. Pulmonary manifestations of pSS are diverse with involvement of airway and/or lung parenchyma. Histopathology of lung lesions suggests a predominance of submucosal mononuclear cell infiltration consisting predominantly of CD4+ T cells. Current understanding of the pathophysiology of lung disease in pSS suggests a similar process driving the pulmonary process as those in the salivary glands, with epithelial cells playing a critical role in the initiation, maintenance, and symptomatology of the disease. Clinical manifestations of lung involvement in pSS are as varied as the underlying pathology and can be vague and non-specific, thus delaying diagnosis. Management options depend on the underlying pathology but are generally limited due to lack of systematic randomized controlled trials. This review helps summarize our current understanding of lung involvement in pSS.
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Affiliation(s)
- Sarthak Gupta
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Marcela A Ferrada
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Sarfaraz A Hasni
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, United States
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Vivino FB, Bunya VY, Massaro-Giordano G, Johr CR, Giattino SL, Schorpion A, Shafer B, Peck A, Sivils K, Rasmussen A, Chiorini JA, He J, Ambrus JL. Sjogren's syndrome: An update on disease pathogenesis, clinical manifestations and treatment. Clin Immunol 2019; 203:81-121. [PMID: 31022578 DOI: 10.1016/j.clim.2019.04.009] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 04/19/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Frederick B Vivino
- Penn Sjögren's Center, Penn Presbyterian Medical Center, University of Pennsylvania Perelman School of Medicine, 3737 Market Street, Philadelphia, PA 19104, USA.
| | - Vatinee Y Bunya
- Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 N. 39(th) Street, Philadelphia, PA 19104, USA.
| | - Giacomina Massaro-Giordano
- Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 N. 39(th) Street, Philadelphia, PA 19104, USA.
| | - Chadwick R Johr
- Penn Sjögren's Center, Penn Presbyterian Medical Center, University of Pennsylvania Perelman School of Medicine, 3737 Market Street, Philadelphia, PA 19104, USA.
| | - Stephanie L Giattino
- Penn Sjögren's Center, Penn Presbyterian Medical Center, University of Pennsylvania Perelman School of Medicine, 3737 Market Street, Philadelphia, PA 19104, USA.
| | - Annemarie Schorpion
- Penn Sjögren's Center, Penn Presbyterian Medical Center, University of Pennsylvania Perelman School of Medicine, 3737 Market Street, Philadelphia, PA 19104, USA.
| | - Brian Shafer
- Scheie Eye Institute, University of Pennsylvania Perelman School of Medicine, 51 N. 39(th) Street, Philadelphia, PA 19104, USA.
| | - Ammon Peck
- Department of Infectious Diseases and Immunology, University of Florida College of Veterinary Medicine, PO Box 100125, Gainesville, FL 32610, USA.
| | - Kathy Sivils
- Oklahoma Medical Research Foundation, Arthritis and Clinical Immunology Program, 825 NE 13th Street, OK 73104, USA.
| | - Astrid Rasmussen
- Oklahoma Medical Research Foundation, Arthritis and Clinical Immunology Program, 825 NE 13th Street, OK 73104, USA.
| | - John A Chiorini
- NIH, Adeno-Associated Virus Biology Section, National Institute of Dental and Craniofacial Research, Building 10, Room 1n113, 10 Center DR Msc 1190, Bethesda, MD 20892-1190, USA.
| | - Jing He
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
| | - Julian L Ambrus
- Division of Allergy, Immunology and Rheumatology, SUNY at Buffalo School of Medicine, 100 High Street, Buffalo, NY 14203, USA.
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Mittal S, Madan K. A 58-year-old lady with cough and breathlessness. Lung India 2019; 36:70-71. [PMID: 30604709 PMCID: PMC6330811 DOI: 10.4103/lungindia.lungindia_278_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Saurabh Mittal
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
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18
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Jhorar P, Torre K, Lu J. Cutaneous features and diagnosis of primary Sjögren syndrome: An update and review. J Am Acad Dermatol 2018; 79:736-745. [DOI: 10.1016/j.jaad.2018.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 05/02/2018] [Accepted: 05/14/2018] [Indexed: 12/25/2022]
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Dong X, Zhou J, Guo X, Li Y, Xu Y, Fu Q, Lu Y, Zheng Y. A retrospective analysis of distinguishing features of chest HRCT and clinical manifestation in primary Sjögren's syndrome-related interstitial lung disease in a Chinese population. Clin Rheumatol 2018; 37:2981-2988. [PMID: 30242640 DOI: 10.1007/s10067-018-4289-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 09/03/2018] [Accepted: 09/09/2018] [Indexed: 01/20/2023]
Abstract
To characterize the distinctive chest high-resolution computerized tomography (HRCT) features and clinical manifestations of primary Sjögren syndrome (pSS)-related interstitial lung disease (ILD). The demographic data, clinical manifestations, and laboratory and radiological findings of 527 pSS patients were retrospectively analyzed. ILD was defined based on the presences of pulmonary signs in HRCT. Two hundred six of 527 patients were diagnosed as pSS-ILD, and the prevalence was 39.1%. The three most frequent abnormalities in HRCT were reticular pattern (92.7%), ground-glass attenuation (87.4%), and bronchovascular bundle thickening (82%). One hundred twenty-four cases (60.2%) of the pSS-ILD patients had only a single HRCT pattern, which involved 86 non-specific interstitial pneumonitis (NSIP) cases (41.7%), 22 usual interstitial pneumonia (UIP) cases (10.68%), 8 organizing pneumonia (OP) cases (3.9%), and 8 lymphocytic interstitial pneumonia (LIP) cases (3.9%), respectively. Besides, the more important observation was that 82 cases had no less than two HRCT patterns, and NSIP admixed with OP (43.9%), NSIP admixed with UIP (35.4%), and NSIP admixed with LIP (19.5%) were the most frequent. HRCT of pSS-ILD patients demonstrated bilateral infiltrates (99%), with abnormalities predominantly in the lower lobes (89.3%) and subpleural areas (81.1%), and a few lesions were characterized by hilum distributed (8.7%). Pulmonary function tests (PFTs) revealed impaired diffusion capacity for carbon monoxide and total lung capacity, and the rate of small airway lesions in the pSS-ILD patients was 3.5 times higher in patients of pSS. Logistic regression analysis showed that dry cough (OR 59.05), clubbing (OR 6.26), elevated lactate dehydrogenase (OR 21.38) and positive anti-Ro (OR 7.86) were relevant factors of pSS-ILD. ILD is the common pulmonary involvement of pSS and the prevalence of pSS-ILD is 39.1%. The single pattern of NSIP and UIP in HRCT are the commonest, and about 40% of the pSS-ILD patients possess multiple patterns in HRCT. The classification of idiopathic pulmonary fibrosis cannot completely include the pulmonary imaging features of pSS-ILD.
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Affiliation(s)
- Xin Dong
- Department of Rheumatology and Immunology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gong-Ti South Road, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Junfei Zhou
- Department of Rheumatology and Immunology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gong-Ti South Road, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Xiaojuan Guo
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yifan Li
- Department of Rheumatology and Immunology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gong-Ti South Road, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Yuetong Xu
- Department of Rheumatology and Immunology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gong-Ti South Road, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Qiang Fu
- Department of Rheumatology and Immunology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gong-Ti South Road, Chaoyang District, Beijing, 100020, People's Republic of China
| | - Yong Lu
- Department of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yi Zheng
- Department of Rheumatology and Immunology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gong-Ti South Road, Chaoyang District, Beijing, 100020, People's Republic of China.
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21
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Wang Y, Hou Z, Qiu M, Ye Q. Risk factors for primary Sjögren syndrome-associated interstitial lung disease. J Thorac Dis 2018; 10:2108-2117. [PMID: 29850114 DOI: 10.21037/jtd.2018.03.120] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Primary Sjögren syndrome (pSS) is a chronic inflammatory autoimmune disease that is characterized by lymphocytic infiltration of the exocrine glands and extraglandular organ systems. Interstitial lung disease (ILD) is common in pSS patients and is one of the independent risk factors for a poor prognosis. The previously reported characteristics and potential risks contributing to pSS-associated ILD have been controversial. Methods A cohort of 201 newly diagnosed pSS patients were studied over a period of 3 years. Data were from clinical charts. The pSS patients were classified into two groups, namely pSS-ILD or pSS without ILD, according to the lung evaluation. Results In total, the prevalence of pSS-associated ILD was 78.6%. The pSS patients associated ILD were more likely to be male, older and smokers in comparison to the pSS patients without ILD. There were no significant differences in multiorgan involvement between the two groups. Nonspecific interstitial pneumonia (NSIP) was the most common radiological pattern (45.5%). pSS with ILD was associated with increasing age [odds ratio (OR) =1.073], smoking (OR =8.544) and antinuclear antibody (ANA) positive (OR =3.286). Over a median follow-up period of 24 months (range, 18-30 months), no patients died, experienced acute exacerbation of ILD, or had newly diagnosed pSS-ILD. Conclusions pSS associated ILD were more commonly in males, older patients and smokers. Aging, cigarette smoking, and ANA positivity may be potential risk factors contributing to ILD in pSS patients.
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Affiliation(s)
- Yong Wang
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.,Department of Respiratory Medicine, Civil Aviation General Hospital, Beijing 100123, China
| | - Ziliang Hou
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Meihua Qiu
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Qiao Ye
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
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22
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Atzeni F, Gerardi MC, Barilaro G, Masala IF, Benucci M, Sarzi-Puttini P. Interstitial lung disease in systemic autoimmune rheumatic diseases: a comprehensive review. Expert Rev Clin Immunol 2017; 14:69-82. [DOI: 10.1080/1744666x.2018.1411190] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Fabiola Atzeni
- Maurizio Benucci, Rheumatology Unit, San Giovanni Di Dio Hospital, Florence, Italy
| | - Maria Chiara Gerardi
- Rheumatology Unit, Department of Internal Medicine, ASST-Fatebenefratelli L. Sacco University Hospital, Milan, Italy
| | | | | | - Maurizio Benucci
- Rheumatology Unit, Department of Internal Medicine, ASST-Fatebenefratelli L. Sacco University Hospital, Milan, Italy
| | - Piercarlo Sarzi-Puttini
- Rheumatology Unit, Department of Internal Medicine, ASST-Fatebenefratelli L. Sacco University Hospital, Milan, Italy
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Abstract
PURPOSE OF REVIEW Interstitial lung disease (ILD) is comprised of a heterogeneous group of disorders with highly variable natural histories and response to therapies. Pharmacogenetics focuses on the variability in drug response because of the presence of genetic factors that influence drug metabolism or disease activity. In this article, we review relevant drug-specific and disease-specific polymorphisms that may influence therapeutic response, and then highlight a recently identified drug-gene interaction in patients with idiopathic pulmonary fibrosis (IPF). RECENT FINDINGS The emergence of high-throughput genomic technology has allowed for identification of gene polymorphisms associated with susceptibility to specific disease states, including IPF and several connective tissue diseases known to cause ILD. IPF risk loci span a diverse group of genes, while most associated with connective tissue disease are critical to immune signaling. A recent pharmacogenetic analysis of patients enrolled in an IPF clinical trial identified a variant within TOLLIP to be associated with differential response to N-acetylcysteine therapy. SUMMARY Though few pharmacogenetic investigations have been conducted in patients with ILD to date, ample opportunities for pharmacogenetic exploration exist in this patient population. Such exploration will advance our understanding of specific ILDs and help usher in an era of personalized medicine.
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Koo SM, Uh ST. Treatment of connective tissue disease-associated interstitial lung disease: the pulmonologist's point of view. Korean J Intern Med 2017; 32:600-610. [PMID: 28704913 PMCID: PMC5511941 DOI: 10.3904/kjim.2016.212] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 06/16/2017] [Indexed: 01/21/2023] Open
Abstract
Interstitial lung disease (ILD) occurs in 15% of patients with collagen vascular disease (CVD), referred to as connective tissue disease (CTD). Despite advances in management strategies, ILD continues to be a significant cause of mortality in patients with CVD-associated ILD (CTD-ILD). There is a lack of randomized, clinical trials assessing pharmacological agents for CTD-ILD, except in cases of ILD-associated systemic sclerosis (SSc). This may be due to the lack of CTD cases available, the difficulty of histological confirmation of ILD, and the various types of CTD and ILD. As a result, evidence-based pharmacological treatment of CTD-ILD is not yet well established. CTD-ILD presents with varying degrees of histology, from inflammation to fibrosis, and a wide spectrum of clinical manifestations, from minimal symptoms to respiratory failure. This renders it difficult for clinicians to make decisions regarding treatment options, observational strategies, optimal timing for interventions, and the appropriateness of pharmacological agents for treatment. There is no specific treatment for reversing fibrosis-like idiopathic pulmonary fibrosis in a clinical setting. This review describes pharmacological interventions for SSc-ILD described in randomized control trials, and presents an overview of recent advances of CTD-ILD-dependent treatments based on the types of CTD.
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Affiliation(s)
| | - Soo-Taek Uh
- Correspondence to Soo-Taek Uh, M.D. Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soon Chun Hyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea Tel: +82-2-709-9482 Fax: +82-2-793-9965 E-mail:
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25
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Enomoto Y, Nakamura Y, Colby TV, Inui N, Suda T. Pirfenidone for primary Sjögren's syndrome-related fibrotic interstitial pneumonia. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2017; 34:91-96. [PMID: 32476828 DOI: 10.36141/svdld.v34i1.5091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 03/14/2016] [Indexed: 11/02/2022]
Abstract
Primary Sjögren's syndrome-related interstitial pneumonia (pSS-IP) is occasionally progressive even with immunosuppressive therapy and new treatment options are warranted. A 42-year-old woman was diagnosed with pSS-IP with pathological usual interstitial pneumonia pattern. Although her forced vital capacity (FVC) had temporarily improved after prednisolone therapy, it deteriorated during the prednisolone tapering off period. Therefore, pirfenidone was added in conjunction with prednisolone. During the 12-month treatment period, her FVC was almost stable. A 62-year-old man, a current heavy smoker, was diagnosed with pSS-IP. Chest computed tomography showed bilateral honeycombing with ground-glass attenuation on a background of emphysema. He gradually developed dyspnea on exertion and his FVC deteriorated. Hence, pirfenidone was administered as a monotherapy. Six months later, his FVC and exercise tolerance had significantly improved. Pirfenidone might have a role for the treatment of pSS-IP. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 91-96).
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Affiliation(s)
- Yasunori Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
| | - Thomas V Colby
- Department of Laboratory Medicine and Pathology, Mayo Clinic, USA
| | - Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan.,Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
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Flament T, Bigot A, Chaigne B, Henique H, Diot E, Marchand-Adam S. Pulmonary manifestations of Sjögren's syndrome. Eur Respir Rev 2017; 25:110-23. [PMID: 27246587 DOI: 10.1183/16000617.0011-2016] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/02/2016] [Indexed: 01/22/2023] Open
Abstract
In 9-20% of cases, Sjögren's syndrome is associated with various respiratory symptoms. The most typical manifestations are chronic interstitial lung disease (ILD) and tracheobronchial disease. The most common manifestation of ILD is nonspecific interstitial pneumonia in its fibrosing variant. Other types of ILD, such as organising pneumonia, usual interstitial pneumonia and lymphocytic interstitial pneumonitis, are rare. Their radiological presentation is less distinctive, and definitive diagnosis may require the use of transbronchial or surgical lung biopsy. Corticosteroid therapy is the mainstay of ILD treatment in Sjögren's syndrome, but the use of other immunosuppressive drugs needs to be determined. ILD is a significant cause of death in Sjögren's syndrome. Tracheobronchial disease is common in Sjögren's syndrome, characterised by diffuse lymphocytic infiltration of the airway. It is sometimes responsible for a crippling chronic cough. It can also present in the form of bronchial hyperresponsiveness, bronchiectasis, bronchiolitis or recurrent respiratory infections. The management of these manifestations may require treatment for dryness and/or inflammation of the airways. Airway disease has little effect on respiratory function and is rarely the cause of death in Sjögren's syndrome patients. Rare respiratory complications such as amyloidosis, lymphoma or pulmonary hypertension should not be disregarded in Sjögren's syndrome patients.
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Affiliation(s)
| | - Adrien Bigot
- Service de Médecine Interne, CHRU Tours, Tours, France
| | | | - Helene Henique
- Service de Pneumologie, CHRU Tours, Tours, France Service de Médecine Interne, CHRU Tours, Tours, France Université François Rabelais, UMR 1100, Tours, France INSERM, Centre d'Etude des Pathologies Respiratoires, UMR 1100/EA6305, Tours, France
| | | | - Sylvain Marchand-Adam
- Service de Pneumologie, CHRU Tours, Tours, France Université François Rabelais, UMR 1100, Tours, France INSERM, Centre d'Etude des Pathologies Respiratoires, UMR 1100/EA6305, Tours, France
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Kim HJ, Kim KH, Hann HJ, Han S, Kim Y, Lee SH, Kim DS, Ahn HS. Incidence, mortality, and causes of death in physician-diagnosed primary Sjögren's syndrome in Korea: A nationwide, population-based study. Semin Arthritis Rheum 2017; 47:222-227. [PMID: 28729155 DOI: 10.1016/j.semarthrit.2017.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/27/2017] [Accepted: 03/07/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The objective of this study was to investigate the epidemiological features of primary Sjögren's syndrome (pSS) in Korea at a national level, including the incidence, mortality, and causes of death. METHODS We used a national, population-based registry database called the Rare Intractable Disease Registration Program from the Health Insurance Review and Assessment Service to obtain pSS patient data for the period between 2010 and 2014. pSS was diagnosed by a physician based on uniform criteria. We also used data from Statistics Korea to confirm the mortality and causes of death. RESULTS Between 2010 and 2014, the total number of patients newly diagnosed with pSS was 5891, resulting in an annual incidence of 2.34 per 100,000 individuals. The female-to-male ratio was 14.5:1. A total of 114 pSS patients died during the study period. The overall survival rate of pSS patients was 99.0%, and the 1-year, 2-year, and 5-year survival rates were 98.7%, 98.1%, and 97.1%, respectively, and the standardized mortality ratio (SMR) was 1.47 (2.14 for males and 1.35 for females). The most common causes of death were respiratory disease (n = 25; 21.9%) followed by circulatory diseases (n = 21; 18.4%), musculoskeletal connective tissue diseases (n = 21; 18.4%), and cancer (n=19; 16.7%). CONCLUSIONS The national incidence of pSS in Korea presented in this study was lower in comparison with reports from other countries. However, the mortality rate was significantly higher than the corresponding values in the age- and gender-matched general population. The higher mortality in pSS patients is attributable to respiratory diseases and lung cancer.
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Affiliation(s)
- Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kyoung Hoon Kim
- Department of Public Health, Graduate School, Korea University, Seoul, Republic of Korea; Health Insurance Review and Assessment Service, Republic of Korea
| | - Hoo Jae Hann
- Medical Research Institute, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
| | - Seungjin Han
- Department of Public Health, Graduate School, Korea University, Seoul, Republic of Korea; Health Insurance Review and Assessment Service, Republic of Korea
| | - Yuri Kim
- Department of Public Health, Graduate School, Korea University, Seoul, Republic of Korea; Health Insurance Review and Assessment Service, Republic of Korea
| | - Sang Hyuk Lee
- Department of Public Health, Graduate School, Korea University, Seoul, Republic of Korea
| | - Dong Sook Kim
- Department of Public Health, Graduate School, Korea University, Seoul, Republic of Korea; Health Insurance Review and Assessment Service, Republic of Korea
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea.
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Ludviksdottir D, Valtysdottir ST, Hedenström H, Hällgren R, Gudbjörnsson B. Eight-year follow-up of airway hyperresponsiveness in patients with primary Sjögren's syndrome. Ups J Med Sci 2017; 122:51-55. [PMID: 27849141 PMCID: PMC5361432 DOI: 10.1080/03009734.2016.1239663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate in a longitudinal study the influence of airway hyperresponsiveness (AHR) on lung function in patients with primary Sjögren's syndrome (pSS). METHODS Lung function was studied over an eight-year period in 15 patients who fulfilled the Copenhagen criteria for primary Sjögren's syndrome and who were covered in our earlier published study on AHR in patients with Sjögren's syndrome. Standard spirometry and measurements of lung volumes, diffusing capacity (DLCO), and AHR to methacholine were performed. RESULTS A significant decline over time was found in total lung capacity (TLC), vital capacity (VC), forced vital capacity (FVC), functional residual capacity (FRC), and expiratory midflows (FEF50). A sign of small airway obstruction (decrease in FEF50) at entry correlated with VC at follow-up (r = .8, P < .003), and the individual change in FEF50 during the observation period correlated with the individual change in VC (r = .6, P < .05). Six patients had increased AHR, and three of them had decreased DLCO. Six of the patients progressively reduced DLCO over time, and five of them had spirometric signs of increased small airway obstruction. CONCLUSIONS During this eight-year follow-up we observed that one-third of the patients with pSS developed a significant reduction in lung function. Our findings suggest that small airways obstruction and AHR are associated with reduction of VC and development of impaired DLCO as a sign of interstitial lung disease in this group of patients.
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Affiliation(s)
- Dora Ludviksdottir
- Department of Allergy, University Hospital, Reykjavik, Iceland
- Department of Respiratory Medicine, University Hospital, Reykjavik, Iceland
- CONTACT Dora Ludviksdottir Department of Allergy and Respiratory Medicine, Landspitali, University Hospital, Reykjavik, Iceland
| | | | - Hans Hedenström
- Department of Clinical Physiology, Akademiska Sjukhuset, Uppsala University Hospital, Uppsala, Sweden
| | - Roger Hällgren
- Department of Medical Sciences, Akademiska Sjukhuset, Uppsala University Hospital, Uppsala, Sweden
| | - Björn Gudbjörnsson
- Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Roca F, Dominique S, Schmidt J, Smail A, Duhaut P, Lévesque H, Marie I. Interstitial lung disease in primary Sjögren's syndrome. Autoimmun Rev 2017; 16:48-54. [DOI: 10.1016/j.autrev.2016.09.017] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/08/2016] [Indexed: 12/21/2022]
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30
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Management of connective tissue diseases associated interstitial lung disease: a review of the published literature. Curr Opin Rheumatol 2016; 28:236-45. [PMID: 27027811 DOI: 10.1097/bor.0000000000000270] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Interstitial lung disease (ILD), though a common and often a severe manifestation of many connective tissue diseases (CTD), is challenging to manage because of its variable presentation and the relative lack of guidelines to assist the clinician. In this review, we discuss the approach to diagnosis, treatment, and monitoring patients with CTD-associated ILD, with a focus on systemic sclerosis (SSc), rheumatoid arthritis (RA), and idiopathic inflammatory myopathy (IIM). RECENT FINDINGS High-resolution computed tomography scan and pulmonary function testing can be reliably used to diagnose ILD and monitor progression, and often to determine its likely histologic subtype and severity. In SSc-ILD, randomized controlled trials show ILD stabilization with cyclophosphamide treatment; preliminary data from another randomized controlled trial demonstrates similar findings with mycophenolate. There are no robust clinical trials supporting specific treatments for RA-ILD or IIM-ILD, but rituximab in RA-ILD, and cyclophosphamide, mycophenolate and calcineurin inhibitors in IIM-ILD show promise. SUMMARY Though ILD contributes substantially to morbidity and mortality in patients with CTD, there are minimal data to guide its management except in SSc-ILD.
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Oldham JM, Lee C, Valenzi E, Witt LJ, Adegunsoye A, Hsu S, Chen L, Montner S, Chung JH, Noth I, Vij R, Strek ME. Azathioprine response in patients with fibrotic connective tissue disease-associated interstitial lung disease. Respir Med 2016; 121:117-122. [PMID: 27888985 DOI: 10.1016/j.rmed.2016.11.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/30/2016] [Accepted: 11/02/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Azathioprine is a commonly prescribed therapy for connective tissue disease-associated interstitial lung disease (CTD-ILD). Combination therapy that included azathioprine was recently shown to increase the risk of death and hospitalization in patients with idiopathic pulmonary fibrosis. Whether azathioprine increases the risk of adverse outcomes in patients with fibrotic CTD-ILD, including those with CTD-associated usual interstitial pneumonia (UIP), remains unknown. METHODS A retrospective cohort analysis was performed to determine the combined incidence rate of death, transplant and respiratory hospitalization associated with azathioprine exposure. A fibrotic CTD-ILD cohort treated with mycophenolate mofetil served as a comparator group. Incidence rates were compared with an incidence rate ratio (IRR) generated by negative binomial regression. Longitudinal pulmonary function response was then assessed using mixed effects linear regression models. RESULTS Fifty-four patients were treated with azathioprine and forty-three with mycophenolate. Medication discontinuation due to non-respiratory side effects occurred in 27% and 5% of the azathioprine and mycophenolate cohorts, respectively. The combined incidence rate of adverse outcomes was 0.015 and 0.013 for azathioprine and mycophenolate, respectively (IRR 1.23; 95% CI 0.49-3.12; p = 0.66). Similar incidence rates were observed among those with CTD-UIP (IRR 0.83; 95% CI 0.21-3.31; p = 0.79). Both groups demonstrated pulmonary function stability over time, with the azathioprine group demonstrating a marginal improvement. CONCLUSIONS A significant minority of patients could not tolerate azathioprine due to non-respiratory side effects. Of those who did tolerate azathioprine, a similar incidence of adverse outcomes was observed as those treated with mycophenolate. Both therapies were associated with stability in pulmonary function.
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Affiliation(s)
- Justin M Oldham
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, The University of California at Davis, United States.
| | - Cathryn Lee
- Department of Medicine, The University of Chicago, United States
| | - Eleanor Valenzi
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, The University of Pittsburgh, United States
| | - Leah J Witt
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, The University of Chicago, United States
| | - Ayodeji Adegunsoye
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, The University of Chicago, United States
| | - Scully Hsu
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, The University of Chicago, United States
| | - Lena Chen
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, The University of Chicago, United States
| | - Steven Montner
- Department of Radiology, The University of Chicago, United States
| | - Jonathan H Chung
- Department of Radiology, The University of Chicago, United States
| | - Imre Noth
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, The University of Chicago, United States
| | - Rekha Vij
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, The University of Chicago, United States
| | - Mary E Strek
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, The University of Chicago, United States
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Both T, Zillikens MC, Hoorn EJ, Zietse R, van Laar JAM, Dalm VASH, van Duijn CM, Versnel MA, Maria NI, van Hagen PM, van Daele PLA. Bone Mineral Density in Sjögren Syndrome Patients with and Without Distal Renal Tubular Acidosis. Calcif Tissue Int 2016; 98:573-9. [PMID: 26873478 PMCID: PMC4860192 DOI: 10.1007/s00223-016-0112-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 01/18/2016] [Indexed: 11/29/2022]
Abstract
Primary Sjögren's syndrome (pSS) can be complicated by distal renal tubular acidosis (dRTA), which may contribute to low bone mineral density (BMD). Our objective was to evaluate BMD in pSS patients with and without dRTA as compared with healthy controls. BMD of lumbar spine (LS) and femoral neck (FN) was measured in 54 pSS patients and 162 healthy age- and sex-matched controls by dual-energy X-ray absorptiometry (DXA). dRTA was defined as inability to reach urinary pH <5.3 after an ammonium chloride (NH4Cl) test. LS- and FN-BMD were significantly higher in pSS patients compared with controls (1.18 ± 0.21 g/cm(2) for patients vs. 1.10 ± 0.18 g/cm(2) for controls, P = 0.008 and 0.9 ± 0.16 g/cm(2) for patients vs. 0.85 ± 0.13 g/cm(2) for controls, P = 0.009, respectively). After adjustment for BMI and smoking, the LS- and FN-BMD remained significantly higher. Patients with dRTA (N = 15) did not have a significantly different LS- and FN-BMD compared with those without dRTA (N = 39) after adjustment for BMI, age, and gender. Thirty-seven (69 %) pSS patients were using hydroxychloroquine (HCQ). Unexpectedly, pSS patients had a significantly higher LS- and FN-BMD compared with healthy controls. Patients with dRTA had similar BMD compared with patients without dRTA. We postulate that an explanation for the higher BMD in pSS patients may be the frequent use of HCQ.
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Affiliation(s)
- Tim Both
- Division of Clinical Immunology, Department of Internal Medicine, PO Box 2040, Room D-419, 3000 CA, Rotterdam, The Netherlands.
| | - M Carola Zillikens
- Department of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ewout J Hoorn
- Department of Nephrology & Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robert Zietse
- Department of Nephrology & Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan A M van Laar
- Division of Clinical Immunology, Department of Internal Medicine, PO Box 2040, Room D-419, 3000 CA, Rotterdam, The Netherlands
- Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Virgil A S H Dalm
- Division of Clinical Immunology, Department of Internal Medicine, PO Box 2040, Room D-419, 3000 CA, Rotterdam, The Netherlands
- Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Marjan A Versnel
- Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Naomi I Maria
- Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - P Martin van Hagen
- Division of Clinical Immunology, Department of Internal Medicine, PO Box 2040, Room D-419, 3000 CA, Rotterdam, The Netherlands
- Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Paul L A van Daele
- Division of Clinical Immunology, Department of Internal Medicine, PO Box 2040, Room D-419, 3000 CA, Rotterdam, The Netherlands
- Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
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van Nimwegen JF, Moerman RV, Sillevis Smitt N, Brouwer E, Bootsma H, Vissink A. Safety of treatments for primary Sjögren's syndrome. Expert Opin Drug Saf 2016; 15:513-24. [PMID: 26809028 DOI: 10.1517/14740338.2016.1146676] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Primary Sjögren's syndrome (pSS) is a disabling auto-immune disease, affecting exocrine glands and several organs. AREAS COVERED In this review we analyze the safety of therapies used in pSS. Symptomatic treatment is widely applied due to the good supportive effect and good safety profile. Systemic stimulation of tears and saliva can be successful in pSS. However, cumbersome adverse events can influence the tolerability of this therapy. Evidence for the effectiveness of synthetic DMARDs therapies in pSS is limited, while there is a risk of adverse events. Several studies on biologic DMARD treatment of pSS patients have shown promising efficacy and safety results. EXPERT OPINION The safety of symptomatic treatment of pSS is very good. However, systemic therapy is necessary to achieve long-term relieve and prevention of organ-damage. Synthetic DMARDs have not shown much efficacy in earlier studies, and their benefits do not weigh up to the possible harms, while biologic DMARDs show promising results regarding efficacy and cause mostly mild adverse events. Many questions remain unanswered regarding safety of DMARDs in pSS. There is a need for well designed studies, in which safety should be evaluated in a uniform manner to be able to compare the results between studies.
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Affiliation(s)
- Jolien F van Nimwegen
- a Department of Rheumatology and Clinical Immunology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Rada V Moerman
- a Department of Rheumatology and Clinical Immunology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Nicole Sillevis Smitt
- b Department of Ophthalmology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Elisabeth Brouwer
- a Department of Rheumatology and Clinical Immunology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Hendrika Bootsma
- a Department of Rheumatology and Clinical Immunology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Arjan Vissink
- c Department of Oral and Maxillofacial Surgery , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
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Jo HE, Corte TJ, Moodley Y, Levin K, Westall G, Hopkins P, Chambers D, Glaspole I. Evaluating the interstitial lung disease multidisciplinary meeting: a survey of expert centres. BMC Pulm Med 2016; 16:22. [PMID: 26831722 PMCID: PMC4736654 DOI: 10.1186/s12890-016-0179-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 01/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multidisciplinary meetings (MDM) are the current "gold standard" in interstitial lung disease (ILD) diagnosis and comprise inter-disciplinary discussion of multiple forms of information to provide diagnostic and management outputs. Although bias could be potentially inserted at any step in the discussion process, to date there has been no consensus regarding the appropriate constitution and governance of MDM. We sought to determine the features of ILD MDMs based within ILD centres of excellence around the world. METHODS An internet based questionnaire was sent to twelve expert centres in Europe, North America, and Australia seeking information regarding the structure and governance of their MDM. Data was analysed for consistent themes and points of contrast. RESULTS Responses were received from 10 out of 12 centres. Similarities were demonstrated with regards to contributing attendees, meeting frequency and case numbers reviewed. Significant heterogeneity in attendee speciality group type, quantity and method of data presentation, approach to diagnosis formulation and documentation, and information provision was apparent. CONCLUSIONS The constitution of ILD MDMs differs considerably between expert centres. Such differences may result in discordant outcomes, and emphasise the need for further evidence regarding the appropriate constitution and governance of ILD MDMs.
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Affiliation(s)
- Helen E Jo
- Royal Prince Alfred Hospital, Sydney, Australia. .,University of Sydney, Sydney, Australia.
| | - Tamera J Corte
- Royal Prince Alfred Hospital, Sydney, Australia. .,University of Sydney, Sydney, Australia.
| | - Yuben Moodley
- University of Western Australia, Perth, Australia. .,Fiona Stanley Hospital, Perth, Australia. .,Respiratory Health Institute, Perth, Australia.
| | - Kovi Levin
- The Alfred Hospital, Melbourne, Australia.
| | - Glen Westall
- The Alfred Hospital, Melbourne, Australia. .,Monash University, Melbourne, Australia.
| | - Peter Hopkins
- Prince Charles Hospital, Brisbane, Australia. .,University of Queensland, Brisbane, Australia.
| | - Daniel Chambers
- Prince Charles Hospital, Brisbane, Australia. .,University of Queensland, Brisbane, Australia.
| | - Ian Glaspole
- The Alfred Hospital, Melbourne, Australia. .,Monash University, Melbourne, Australia.
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35
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Lee JS, Fischer A. Current and emerging treatment options for interstitial lung disease in patients with rheumatic disease. Expert Rev Clin Immunol 2016; 12:509-20. [PMID: 26752397 DOI: 10.1586/1744666x.2016.1139454] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The management of connective tissue disease-associated interstitial lung disease (CTD-ILD) is complex and this arena offers many challenges to the practicing clinician. Unfortunately, treatment strategies and recommendations are often based on experience rather than evidence, and there are few effective therapeutic options. Pharmacologic intervention with immunosuppression is usually the mainstay of therapy and is reserved for those with clinically significant and/or progressive ILD. There is a desperate need for controlled trials across the spectrum of CTD-ILD and a number of potentially promising novel therapies warrant further study. It is important to address co-morbid conditions or aggravating factors (e.g., gastroesophageal reflux, aspiration, bone health, pulmonary hypertension, Pneumocystis jiroveci prophylaxis) and to institute non-pharmacologic management strategies (e.g., supplemental oxygen and cardiopulmonary rehabilitation) as part of a comprehensive treatment plan in CTD-ILD.
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Affiliation(s)
- Joyce S Lee
- a Department of Medicine , University of Colorado School of Medicine , Aurora , CO , USA
| | - Aryeh Fischer
- a Department of Medicine , University of Colorado School of Medicine , Aurora , CO , USA
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36
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Lee EH, Park JE, Goag EK, Kim YJ, Jung IY, Kim CY, Park YM, Lee JM, Park MS. Lymphocytic interstitial pneumonia in a patient with Sjögren's syndrome. Yeungnam Univ J Med 2016. [DOI: 10.12701/yujm.2016.33.2.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Eun Hye Lee
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Eun Park
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Kyong Goag
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Joo Kim
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - In Young Jung
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chi Young Kim
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Mok Park
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Mo Lee
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Moo Suk Park
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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37
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Robles-Perez A, Molina-Molina M. Treatment Considerations of Lung Involvement in Rheumatologic Disease. Respiration 2015; 90:265-74. [DOI: 10.1159/000441238] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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39
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Recommendations for the treatment of Sjögren's syndrome. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 55:446-57. [PMID: 26360421 DOI: 10.1016/j.rbr.2015.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 07/20/2015] [Accepted: 07/23/2015] [Indexed: 12/15/2022] Open
Abstract
The recommendations proposed by the Sjögren's Syndrome Committee of the Brazilian Society of Rheumatology for the treatment of Sjögren's syndrome were based on a systematic review of literature in Medline (PubMed) and the Cochrane databases until October 2014 and on expert opinion in the absence of studies on the subject. 131 items classified according to Oxford & Grade were included. These recommendations were developed in order to guide the appropriate management and facilitate the access to treatment for those patients with an appropriate indication, considering the Brazilian socioeconomic context and pharmacological agents available in this country.
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40
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Abstract
Diffuse cystic and nodular lung diseases have characteristic imaging findings. The most common causes of cystic lung disease are lymphangioleiomyomatosis and Langerhans cell histiocytosis. Other less common cystic lung diseases include Birt-Hogg-Dube syndrome, lymphocytic interstitial pneumonitis, and light chain deposition disease. Computed tomography is used to differentiate cystic lung disease from emphysema, honeycombing, cavities, and bronchiectasis, which mimic cystic lung disease. Diffuse nodular lung disease are categorized as centrilobular, perilymphatic, and random types. In diffuse nodular lung disease, a specific diagnosis is achieved through a combination of history, physical examination, and imaging findings.
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Affiliation(s)
- J Caleb Richards
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
| | - David A Lynch
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - Jonathan H Chung
- Department of Radiology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
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41
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Mira-Avendano IC, Abril A. Pulmonary manifestations of Sjögren syndrome, systemic lupus erythematosus, and mixed connective tissue disease. Rheum Dis Clin North Am 2015; 41:263-77. [PMID: 25836642 DOI: 10.1016/j.rdc.2015.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Interstitial lung disease is a common and often life-threatening manifestation of different connective tissue disorders, often affecting its overall prognosis. Systemic lupus erythematosus, Sjögren syndrome, and mixed connective tissue disease, although all unique diseases, can have lung manifestations as an important part of these conditions. This article reviews the different pulmonary manifestations seen in these 3 systemic rheumatologic conditions.
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Affiliation(s)
- Isabel C Mira-Avendano
- Department of Pulmonary Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
| | - Andy Abril
- Department of Rheumatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 33224, USA
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42
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Yaciuk JC, Pan Y, Schwarz K, Pan ZJ, Maier-Moore JS, Kosanke SD, Lawrence C, Farris AD. Defective selection of thymic regulatory T cells accompanies autoimmunity and pulmonary infiltrates in Tcra-deficient mice double transgenic for human La/Sjögren's syndrome-B and human La-specific TCR. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2015; 194:1514-22. [PMID: 25582858 PMCID: PMC4323622 DOI: 10.4049/jimmunol.1400319] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A human La/Sjögren's syndrome-B (hLa)-specific TCR/hLa neo-self-Ag double-transgenic (Tg) mouse model was developed and used to investigate cellular tolerance and autoimmunity to the ubiquitous RNA-binding La Ag often targeted in systemic lupus erythematosus and Sjögren's syndrome. Extensive thymic clonal deletion of CD4(+) T cells occurred in H-2(k/k) double-Tg mice presenting high levels of the I-E(k)-restricted hLa T cell epitope. In contrast, deletion was less extensive in H-2(k/b) double-Tg mice presenting lower levels of the epitope, and some surviving thymocytes were positively selected as thymic regulatory T cells (tTreg). These mice remained serologically tolerant to hLa and healthy. H-2(k/b) double-Tg mice deficient of all endogenous Tcra genes, a deficiency known to impair Treg development and function, produced IgG anti-hLa autoantibodies and displayed defective tTreg development. These autoimmune mice had interstitial lung disease characterized by lymphocytic aggregates containing Tg T cells with an activated, effector memory phenotype. Salivary gland infiltrates were notably absent. Thus, expression of nuclear hLa Ag induces thymic clonal deletion and tTreg selection, and lymphocytic infiltration of the lung is a consequence of La-specific CD4(+) T cell autoimmunity.
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Affiliation(s)
- Jane C Yaciuk
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104; Department of Microbiology and Immunology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104; and
| | - Yujun Pan
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104
| | - Karen Schwarz
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104
| | - Zi-Jian Pan
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104
| | - Jacen S Maier-Moore
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104
| | - Stanley D Kosanke
- Department of Pathology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
| | - Christina Lawrence
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104
| | - A Darise Farris
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104; Department of Microbiology and Immunology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104; and Department of Microbiology and Immunology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104; and
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Abstract
A thorough, often multidisciplinary assessment to determine extrathoracic versus intrathoracic disease activity and degrees of impairment is needed to optimize the management of connective tissue disease (CTD)-associated interstitial lung disease (ILD). Pharmacologic intervention with immunosuppression is the mainstay of therapy for all forms of CTD-ILD, but should be reserved for those that show clinically significant and/or progressive disease. The management of CTD-ILD is not yet evidence based and there is a need for controlled trials across the spectrum of CTD-ILD. Nonpharmacologic management strategies and addressing comorbidities or aggravating factors should be included in the comprehensive treatment plan for CTD-ILD.
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44
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Yeh JJ, Chen HJ, Li TC, Wong YS, Tang HC, Yeh TC, Kao CH. Association between Sjogren's syndrome and respiratory failure: put airway, interstitia, and vessels close together: a national cohort study. PLoS One 2014; 9:e110783. [PMID: 25350278 PMCID: PMC4211705 DOI: 10.1371/journal.pone.0110783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 09/15/2014] [Indexed: 12/31/2022] Open
Abstract
Objectives Few studies have evaluated the association between Sjogren's syndrome (SS) and respiratory failure (RF). Thus, we conducted a retrospective national cohort study to investigate whether Sjogren's syndrome (SS) increases the risk of respiratory failure (RF). Methods The cohort consisted of 4954 newly diagnosed patients with SS but without a previous diagnosis of RF, and 19816 patients as the comparison cohort from the catastrophic illnesses registry, obtained from the 2000–2005 period. All of the study participants were followed from the index date to December 31, 2011. We analyzed the association between the risk of RF and SS by using a Cox proportional hazards regression model, controlling for sex, age, and comorbidities. Results The overall incidence rate of RF showed a 3.21-fold increase in the SS cohort compared with the comparison cohort. The adjusted HR of RF was 3.04 for the SS cohort compared with the comparison cohort, after we adjusted for sex, age, and comorbidities. The HRs of RF for patients with primary SS and secondary SS compared with the comparison cohort were 2.99 and 3.93, respectively (P for trend <.001). The HRs of RF increased as the severity of SS increased, from 2.34 for those with no inpatient care experience to 5.15 for those with inpatient care experience (P for trend <.001). Conclusion This study indicates that clinical physicians should not only consider secondary SS but also primary SS as a critical factor that increases the risk of RF.
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Affiliation(s)
- Jun-Jun Yeh
- Department of Family Medicine and Pulmonary Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- Meiho University, Pingtung, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Management, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan
| | - Yi-Sin Wong
- Department of Family Medicine and Pulmonary Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Hsien-Chin Tang
- Department of Family Medicine and Pulmonary Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Ting-Chun Yeh
- Department of Family Medicine and Pulmonary Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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45
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Pereira DAS, Kawassaki ADM, Baldi BG. Interpretation of autoantibody positivity in interstitial lung disease and lung-dominant connective tissue disease. J Bras Pneumol 2014; 39:728-41. [PMID: 24473767 PMCID: PMC4075893 DOI: 10.1590/s1806-37132013000600012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 08/13/2013] [Indexed: 11/21/2022] Open
Abstract
The initial evaluation of patients with interstitial lung disease (ILD) primarily
involves a comprehensive, active search for the cause. Autoantibody assays, which can
suggest the presence of a rheumatic disease, are routinely performed at various
referral centers. When interstitial lung involvement is the condition that allows the
definitive diagnosis of connective tissue disease and the classical criteria are met,
there is little debate. However, there is still debate regarding the significance,
relevance, specificity, and pathophysiological role of autoimmunity in patients with
predominant pulmonary involvement and only mild symptoms or formes frustes of
connective tissue disease. The purpose of this article was to review the current
knowledge of autoantibody positivity and to discuss its possible interpretations in
patients with ILD and without clear etiologic associations, as well as to enhance the
understanding of the natural history of an allegedly new disease and to describe the
possible prognostic implications. We also discuss the proposition of a new term to be
used in the classification of ILDs: lung-dominant connective tissue disease.
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Affiliation(s)
| | | | - Bruno Guedes Baldi
- University of São Paulo, School of Medicine, Hospital das Clínicas, São Paulo, Brazil
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46
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Enomoto Y, Takemura T, Hagiwara E, Iwasawa T, Okudela K, Yanagawa N, Baba T, Sakai F, Fukuda Y, Nagaoka S, Ogura T. Features of usual interstitial pneumonia in patients with primary Sjögren׳s syndrome compared with idiopathic pulmonary fibrosis. Respir Investig 2014; 52:227-235. [PMID: 24998369 DOI: 10.1016/j.resinv.2014.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 02/18/2014] [Accepted: 02/23/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND The different characteristics of usual interstitial pneumonia in patients with primary Sjögren׳s syndrome (UIP/pSS) compared with idiopathic pulmonary fibrosis (UIP/IPF) are not fully understood. This study aimed to compare characteristics, prognosis, and treatment responses in these patients. METHODS Among 129 consecutive patients who underwent surgical lung biopsy to diagnose diffuse lung diseases at Kanagawa Cardiovascular and Respiratory Center between 1998 and 2002, we identified 10 and 19 patients with UIP/pSS and UIP/IPF, respectively. Baseline characteristics, chest high-resolution computed tomography (HRCT) and pathological findings, and the clinical course were compared between the two groups. Responses to immunosuppressive therapy were analyzed by comparing pulmonary function and clinical status before and one year after treatment initiation. RESULTS More patients in the UIP/pSS group tended to be female and older than those in the UIP/IPF group (mean age, 68 years vs. 62 years). In addition, they more commonly exhibited enlarged mediastinal lymph nodes and bronchial wall thickening on HRCT. Pathologically, in the UIP/pSS group, interstitial inflammation, plasma cell infiltration, lymphoid follicles with germinal centers, cysts, bronchiolitis, and pleuritis were significantly more prominent, whereas smooth muscle hyperplasia and fibroblastic foci were milder (all P<0.05). The prognosis was better for UIP/pSS compared with UIP/IPF patients (P=0.01). In addition, immunosuppressive therapy provided better disease control for those with UIP/pSS (83%, 5/6) compared UIP/IPF (7%, 1/15). CONCLUSION This study identified distinct clinical, radiological, and pathological characteristics of UIP/pSS compared with UIP/IPF. Immunosuppressive treatment could be a therapeutic option for UIP/pSS.
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Affiliation(s)
- Yasunori Enomoto
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1, Tomioka-Higashi, Kanazawa-ku, Yokohama 236-0051, Japan.
| | - Tamiko Takemura
- Department of Pathology, Japanese Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-ku, Tokyo 150-8935, Japan.
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1, Tomioka-Higashi, Kanazawa-ku, Yokohama 236-0051, Japan.
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, 6-16-1, Tomioka-Higashi, Kanazawa-ku, Yokohama 236-0051, Japan.
| | - Koji Okudela
- Department of Pathobiology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
| | - Noriyo Yanagawa
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1, Tomioka-Higashi, Kanazawa-ku, Yokohama 236-0051, Japan.
| | - Fumikazu Sakai
- Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, 1298, Yamane, Hidaka, Saitama 350-1298, Japan.
| | - Yuh Fukuda
- Department of Diagnostic Pathology, Itabashi Chuo Medical Center, 2-12-7, Azusawa, Itabashi-ku, Tokyo 174-0051, Japan.
| | - Shouhei Nagaoka
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, 1-21-1, Mutsuura-Higashi, Kanazawa-ku, Yokohama 236-0037, Japan.
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1, Tomioka-Higashi, Kanazawa-ku, Yokohama 236-0051, Japan.
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Kambouchner M, Levy P, Nicholson AG, Schubel K, Magois E, Feuillet S, Valeyre D, Bernaudin JF, Nunes H. Prognostic relevance of histological variants in nonspecific interstitial pneumonia. Histopathology 2014; 65:549-60. [DOI: 10.1111/his.12415] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/08/2014] [Indexed: 11/30/2022]
Affiliation(s)
| | - Pierre Levy
- Département de Santé Publique; AP-HP; Hôpital Tenon; Université Pierre et Marie Curie Paris 6; Paris France
| | - Andrew G Nicholson
- Department of Histopathology; Royal Brompton and Harefield NHS Foundation Trust and NHLI Division; Imperial College London; London UK
| | - Kirsten Schubel
- Service de Pneumologie; AP-HP; Hôpital Avicenne; Bobigny France
| | - Eline Magois
- Service de Pneumologie; Hôpital d'Amiens; Université de Picardie Jules Verne; Amiens France
| | - Séverine Feuillet
- Service de Pneumologie; AP-HP Hôpital Saint-Louis; Hôpital Saint Louis; Université Paris Diderot; Sorbonne Paris Cité; Paris France
| | - Dominique Valeyre
- Service de Pneumologie; AP-HP; Hôpital Avicenne; Bobigny France
- Université Paris 13; Sorbonne Paris Cité; Paris France
| | - Jean-François Bernaudin
- Service de Pneumologie; AP-HP; Hôpital Avicenne; Bobigny France
- Service d' Anatomie Pathologique; AP-HP Hôpital Tenon; Université Pierre et Marie Curie Paris 6; Paris France
| | - Hilario Nunes
- Service de Pneumologie; AP-HP; Hôpital Avicenne; Bobigny France
- Université Paris 13; Sorbonne Paris Cité; Paris France
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Banno S, Matsumoto Y, Hayami Y, Sugiura Y, Yoshinouchi T, Ueda R. Pulmonary AL amyloidosis in a patient with primary Sjögren syndrome. Mod Rheumatol 2014; 12:84-8. [PMID: 24383839 DOI: 10.3109/s101650200015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract The condition of a 29-year-old woman with primary Sjögren syndrome (SS) was complicated by amyloid light chains- (AL-) type amyloidosis in the paranasal sinus. She had not complained of respiratory symptoms, but her chest computed tomography (CT) scan revealed bilateral multiple nodular shadows. Lung biopsy specimens using video-associated thoracoscopy showed amyloidoma in a subpleural nodular lesion and amyloid deposits in the interstitial parenchymal walls and pulmonary vessels. Pulmonary AL amyloidosis, presumably related to a chronic inflammatory lymphoproliferative process in SS, has rarely been reported.
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Affiliation(s)
- S Banno
- Second Department of Internal Medicine, Medical School, Nagoya City University , Nagoya , Japan
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Nannini C, Jebakumar AJ, Crowson CS, Ryu JH, Matteson EL. Primary Sjogren's syndrome 1976-2005 and associated interstitial lung disease: a population-based study of incidence and mortality. BMJ Open 2013; 3:e003569. [PMID: 24282246 PMCID: PMC3845035 DOI: 10.1136/bmjopen-2013-003569] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/08/2013] [Accepted: 11/04/2013] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE A very few studies describe the epidemiology of primary Sjögren's syndrome (pSS). The reported frequency of pulmonary involvement in pSS varies widely depending on the detection method employed, and consists mainly of various forms of airways disease. We aimed to evaluate the incidence and mortality of pSS and of lung disease in pSS, focusing on interstitial lung disease (ILD). METHODS A population-based incidence cohort of patients diagnosed with pSS in 1976-2005 was assembled. Diagnosis was based on the 2002 American-European Consensus Group criteria for pSS. Cumulative incidence adjusted for the competing risk of death was estimated. A Cox model with a time-dependent covariate was used to determine the incidence and the standardised mortality HR of pSS. RESULTS 85 patients with pSS were identified (mean age 59.9 years; 91% women). The annual incidence of pSS was 4.2, 95% CI (3.3 to 5.1)/100 000 population and it increased with higher age at pSS diagnosis (18-44 years: 2.1/100 000 vs ≥75 years: 12.3/100 000). Standardised mortality ratio in pSS compared with the general population was 0.92, 95% CI (0.57 to 1.41). A total of 105 patients with pSS and ILD were identified (mean age 58.1 years; 91% women). Among patients with pSS without prior ILD, the cumulative incidence of ILD in patients with pSS was 10% (±3%) at 1 year after diagnosis of pSS and increased to 20% (±4%) by 5 years after pSS. The development of lung disease in pSS was associated with poor survival (HR 2.16; 95% CI 0.99 to 4.74). CONCLUSIONS pSS incidence seems to be almost the same as was reported in a previous study conducted among Olmsted County Minnesota population. Survival among patients with pSS and general population does not differ substantially. However, patients with pSS who have ILD likely have increased premature mortality.
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Affiliation(s)
- Carlotta Nannini
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Internal Medicine, Division of Rheumatology, Prato Hospital, Prato, Italy
| | - Adlene J Jebakumar
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Cynthia S Crowson
- Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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50
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Garcia D, Young L. Lymphocytic interstitial pneumonia as a manifestation of SLE and secondary Sjogren's syndrome. BMJ Case Rep 2013; 2013:bcr-2013-009598. [PMID: 23912652 DOI: 10.1136/bcr-2013-009598] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 47-year-old woman with systemic lupus erythematosus (SLE) diagnosed at age of 35 years was admitted for dyspnoea, substernal chest pain, dry mucosas and difficulty in swallowing. Physical examination revealed vesicular breath sounds bilaterally. Laboratory work showed antinuclear antibody (ANA) (speckled pattern, 1:40), positive anti-Sjogren's syndrome antigen (SSA) and antisingle side band (SSB) and negative double-strand DNA (dsDNA), with normal C3,C4,C50. A high-resolution chest CT scan demonstrated multiple bronchial cysts and diffuse interstitial infiltrates. Surgical lung biopsy revealed emphysematous changes and mild lymphocytic infiltrate around the bronchioles compatible with lymphocytic interstitial pneumonia diagnosis. This case illustrates a patient with primary SLE overlapped by initial manifestations of secondary Sjogren's syndrome (SS) presenting with associated autoimmune interstitial lung disease. Antibody markers, high-resolution chest CT scan and surgical lung biopsy were essential in evaluating this patient, confirming the interstitial lymphocytic infiltration of the lung. Primary SS (pSS) is the most commonly associated disease to lung interstitial pneumonia (LIP) (25%). High-resolution chest CT scan demonstrates areas of ground-glass attenuation, suggestive of interstitial disease. Surgical lung biopsy shows pathologic increase of mature lymphocyte cells and histiocytes. Most of the cases have a benign presentation and shortly relapse. Superimposed infection, pulmonary fibrosis and lymphoma develop in less than 20% of cases. Corticosteroids are the primary therapy. While pSS is commonly associated with interstitial lung involvement, secondary Sjogren's syndrome (sSS) is only rare. It has been described the initial sSS presentation by Sica symptoms development only, and our case is the first report of LIP presentation as initial manifestation of sSS. Our patient remained stable after corticosteroids and hydoxychloroquine therapy and no progression of disease after 6 months follow-up.
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Affiliation(s)
- Daniel Garcia
- Internal Medicine Department, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA.
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