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Mormile I, Mormile M, Rossi FW, Williams M, Valente T, Candia C, Granata F, Rega R, Orlandi M, Matucci-Cerinic M, Molino A, de Paulis A. Radiological patterns and pulmonary function values of lung involvement in primary Sjögren’s syndrome: A pilot analysis. Front Med (Lausanne) 2022; 9:998028. [PMID: 36388884 PMCID: PMC9649970 DOI: 10.3389/fmed.2022.998028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/30/2022] [Indexed: 12/02/2022] Open
Abstract
Background Lung involvement in primary Sjögren’s syndrome (pSS) may vary from 9 to 90%. Interstitial lung disease and tracheobronchial alterations are the most typical findings. The evidence of primarily emphysematous changes at computed tomography of the chest of pSS patients has occasionally been described but poorly characterized. This study aims to assess pulmonary involvement and the impact on respiratory function in a cohort of pSS patients. Materials and methods A total of 22 consecutive patients diagnosed with pSS underwent pulmonary function tests to investigate the presence of ventilatory impairment and evaluate the exchanges of alveolar gases. All patients underwent a chest high-resolution computed tomography (HRTC). Results Dynamic volumes were within the normal range in 21 patients (95.4%). A reduction in the diffusing capacity of the lung for carbon monoxide (DLCO) was observed in 18 patients (81.8%). Ten (45.5%) patients showed a mild degree deficit, while 8 patients (36%) showed a moderate degree deficit. Analysis of DLCO revealed a significant difference between pSS patients and controls [t(30.98) = −10.77; p < 0.001], showing a higher DLCO value for the healthy controls (mean ± SE; 101.27 ± 6.08) compared to pSS patients (mean ± SE; 65.95 ± 12.78). Emphysema was found in 21 (94.5%) patients and was the most widespread pulmonary injury. Tracheal thickness was reduced in 15 (67%) patients. Micronodules were observed in 10 (45%) patients in all the pulmonary fields. Bronchial wall thickening and bronchiectasis were observed in 8 (36%) patients, mainly in the lower lobes. Ground glass was found in 5 (22.5%) patients in lower and higher lobes. Cysts were observed in two patients (9%). Conclusion The reduction of the DLCO could be related to early emphysematous alterations in the absence of spirometric alterations and relevant respiratory symptoms. In conclusion, emphysema might be seen as an early pulmonary involvement mark in patients suffering from pSS.
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Affiliation(s)
- Ilaria Mormile
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Mauro Mormile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Francesca Wanda Rossi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
- Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
- *Correspondence: Francesca Wanda Rossi,
| | - Michela Williams
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Tullio Valente
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Claudio Candia
- Respiratory Division, Department of Respiratory Medicine, University of Naples Federico II, Naples, Italy
| | - Francescopaolo Granata
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Roberto Rega
- Department of Respiratory Medicine, AORN dei Colli, Naples, Italy
| | - Martina Orlandi
- Division of Rheumatology AOUC, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marco Matucci-Cerinic
- Division of Rheumatology AOUC, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Immunology, Rheumatology, Allergy, and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Antonio Molino
- Respiratory Division, Department of Respiratory Medicine, University of Naples Federico II, Naples, Italy
| | - Amato de Paulis
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
- Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
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Nilsson AM, Aaltonen HL, Olsson P, Persson HL, Hesselstrand R, Theander E, Wollmer P, Mandl T. Mixed Airway and Pulmonary Parenchymal Disease in Patients With Primary Sjögren Syndrome: A 6-year Follow-up. J Rheumatol 2020; 48:232-240. [PMID: 32541077 DOI: 10.3899/jrheum.200247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess pulmonary function and chronic obstructive pulmonary disease (COPD) development over time in patients with primary Sjögren syndrome (pSS), as well as the association between pulmonary function, radiographic findings, respiratory symptoms, and clinical features of pSS, taking cigarette consumption into account. METHODS Forty patients with pSS (mean age 66 yrs; range 42-81 yrs; 39 women), previously participating in a cross-sectional study on pulmonary involvement in pSS, were reassessed by pulmonary function tests after a mean follow-up time of 6 years. At follow-up, patients were also assessed by high-resolution computed tomography of the chest, as well as for pSS disease activity, respiratory symptoms, and cigarette consumption. RESULTS Patients with pSS showed significantly decreased percentages of predicted total lung capacity (TLC), residual volume (RV), RV/TLC ratio, and diffusing capacity of the lungs for carbon monoxide, as well as an increase in predicted forced expiratory volume in 1 second/vital capacity (FEV1/VC) ratio from baseline to follow-up. The proportion of COPD in patients with pSS did not change significantly from baseline to follow-up (38% vs 40%, respectively). Radiographic signs of bronchial involvement and interstitial lung disease were each found in 38% of the patients. CONCLUSION Both airway and pulmonary parenchymal disease were commonly found in patients with pSS, with a coexistence of both an obstructive and restrictive pulmonary function pattern, where the latter tended to deteriorate over time. COPD was a common finding. Airway and pulmonary involvement may be underdiagnosed in pSS, which is why special attention to clinical assessment of pulmonary involvement in patients with pSS is mandated.
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Affiliation(s)
- Anna Matilda Nilsson
- A.M. Nilsson, MD, PhD, Department of Clinical Sciences Malmö, Lund University, Malmö, and Department of Rheumatology, Linköping University Hospital, Linköping;
| | - H Laura Aaltonen
- H.L. Aaltonen, MD, PhD, P. Wollmer, MD, PhD, Department of Translational Medicine, Lund University
| | - Peter Olsson
- P. Olsson, MD, PhD, Department of Clinical Sciences Malmö, Lund University, Malmö
| | - Hans Lennart Persson
- H.L. Persson, MD, PhD, Department of Respiratory Medicine in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping
| | - Roger Hesselstrand
- R. Hesselstrand, MD, PhD, Department of Clinical Sciences Lund, Lund University, Lund
| | - Elke Theander
- E. Theander, MD, PhD, Department of Clinical Sciences Malmö, Lund University, and Malmö Jansen Cilag, Solna
| | - Per Wollmer
- H.L. Aaltonen, MD, PhD, P. Wollmer, MD, PhD, Department of Translational Medicine, Lund University
| | - Thomas Mandl
- T Mandl, MD, PhD, Department of Clinical Sciences Malmö, Lund University, Malmö, and Novartis, Kista, Sweden
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Nilsson AM, Diaz S, Theander E, Hesselstrand R, Piitulainen E, Ekberg O, Wollmer P, Mandl T. Chronic obstructive pulmonary disease is common in never-smoking patients with primary Sjögren syndrome. J Rheumatol 2015; 42:464-71. [PMID: 25593235 DOI: 10.3899/jrheum.140370] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the prevalence of chronic obstructive pulmonary disease (COPD) in patients with primary Sjögren syndrome (pSS) and to study the association of COPD with cigarette smoking, radiographic features, respiratory symptoms, disease activity, and laboratory inflammatory and serological features in patients with pSS. METHODS Fifty-one consecutive patients with pSS (mean age 60 yrs, range 29-82 yrs, 49 women) were assessed by pulmonary function tests (PFT). The PFT results were compared with previously studied population-based controls, standardizing results with regard to sex, age, height, weight, and cigarette smoking. In addition, patients with pSS were assessed by computed tomography of the chest, the European League Against Rheumatism Sjögren Syndrome Disease Activity Index and Patient Reported Index, the St. George's Respiratory Questionnaire (which evaluates respiratory symptoms), and by laboratory inflammatory and serological tests. RESULTS Forty-one percent of all patients with pSS and 30% of the never-smoking patients with pSS fulfilled the Global Initiative for Chronic Obstructive Lung Disease criteria for COPD. Vital capacity (VC), forced expiratory volume in 1 s (FEV1), FEV1/VC ratio, and DLCO were significantly decreased while residual volume (RV) and the RV/total lung capacity ratio were significantly increased in patients with pSS. Moderate correlations between PFT results, symptoms, and disease activity were found. However, laboratory inflammatory and serological features were poorly associated with PFT results in patients with pSS. CONCLUSION COPD was a common finding in patients with pSS, even among never-smoking patients. An obstructive pattern was the predominant PFT finding in patients with pSS, although a superimposed restrictive lung disease could not be excluded. The results suggest that the disease per se is involved in the development of COPD in pSS.
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Affiliation(s)
- Anna Matilda Nilsson
- From the Department of Rheumatology, Department of Radiology, Department of Respiratory Medicine, and the Department of Clinical Physiology, Skåne University Hospital, Malmö; Department of Rheumatology, Skåne University Hospital, Lund, Sweden.A.M. Nilsson, MD; E. Theander, MD, PhD; T. Mandl, MD, PhD, Department of Rheumatology; S. Diaz, MD, PhD; O. Ekberg, MD, PhD, Department of Radiology; E. Piitulainen, MD, PhD, Department of Respiratory Medicine, Skåne University Hospital, Malmö; R. Hesselstrand, MD, PhD, Department of Rheumatology, Skåne University Hospital, Lund; P. Wollmer, MD, PhD, Department of Clinical Physiology, Skåne University Hospital, Malmö.
| | - Sandra Diaz
- From the Department of Rheumatology, Department of Radiology, Department of Respiratory Medicine, and the Department of Clinical Physiology, Skåne University Hospital, Malmö; Department of Rheumatology, Skåne University Hospital, Lund, Sweden.A.M. Nilsson, MD; E. Theander, MD, PhD; T. Mandl, MD, PhD, Department of Rheumatology; S. Diaz, MD, PhD; O. Ekberg, MD, PhD, Department of Radiology; E. Piitulainen, MD, PhD, Department of Respiratory Medicine, Skåne University Hospital, Malmö; R. Hesselstrand, MD, PhD, Department of Rheumatology, Skåne University Hospital, Lund; P. Wollmer, MD, PhD, Department of Clinical Physiology, Skåne University Hospital, Malmö
| | - Elke Theander
- From the Department of Rheumatology, Department of Radiology, Department of Respiratory Medicine, and the Department of Clinical Physiology, Skåne University Hospital, Malmö; Department of Rheumatology, Skåne University Hospital, Lund, Sweden.A.M. Nilsson, MD; E. Theander, MD, PhD; T. Mandl, MD, PhD, Department of Rheumatology; S. Diaz, MD, PhD; O. Ekberg, MD, PhD, Department of Radiology; E. Piitulainen, MD, PhD, Department of Respiratory Medicine, Skåne University Hospital, Malmö; R. Hesselstrand, MD, PhD, Department of Rheumatology, Skåne University Hospital, Lund; P. Wollmer, MD, PhD, Department of Clinical Physiology, Skåne University Hospital, Malmö
| | - Roger Hesselstrand
- From the Department of Rheumatology, Department of Radiology, Department of Respiratory Medicine, and the Department of Clinical Physiology, Skåne University Hospital, Malmö; Department of Rheumatology, Skåne University Hospital, Lund, Sweden.A.M. Nilsson, MD; E. Theander, MD, PhD; T. Mandl, MD, PhD, Department of Rheumatology; S. Diaz, MD, PhD; O. Ekberg, MD, PhD, Department of Radiology; E. Piitulainen, MD, PhD, Department of Respiratory Medicine, Skåne University Hospital, Malmö; R. Hesselstrand, MD, PhD, Department of Rheumatology, Skåne University Hospital, Lund; P. Wollmer, MD, PhD, Department of Clinical Physiology, Skåne University Hospital, Malmö
| | - Eeva Piitulainen
- From the Department of Rheumatology, Department of Radiology, Department of Respiratory Medicine, and the Department of Clinical Physiology, Skåne University Hospital, Malmö; Department of Rheumatology, Skåne University Hospital, Lund, Sweden.A.M. Nilsson, MD; E. Theander, MD, PhD; T. Mandl, MD, PhD, Department of Rheumatology; S. Diaz, MD, PhD; O. Ekberg, MD, PhD, Department of Radiology; E. Piitulainen, MD, PhD, Department of Respiratory Medicine, Skåne University Hospital, Malmö; R. Hesselstrand, MD, PhD, Department of Rheumatology, Skåne University Hospital, Lund; P. Wollmer, MD, PhD, Department of Clinical Physiology, Skåne University Hospital, Malmö
| | - Olle Ekberg
- From the Department of Rheumatology, Department of Radiology, Department of Respiratory Medicine, and the Department of Clinical Physiology, Skåne University Hospital, Malmö; Department of Rheumatology, Skåne University Hospital, Lund, Sweden.A.M. Nilsson, MD; E. Theander, MD, PhD; T. Mandl, MD, PhD, Department of Rheumatology; S. Diaz, MD, PhD; O. Ekberg, MD, PhD, Department of Radiology; E. Piitulainen, MD, PhD, Department of Respiratory Medicine, Skåne University Hospital, Malmö; R. Hesselstrand, MD, PhD, Department of Rheumatology, Skåne University Hospital, Lund; P. Wollmer, MD, PhD, Department of Clinical Physiology, Skåne University Hospital, Malmö
| | - Per Wollmer
- From the Department of Rheumatology, Department of Radiology, Department of Respiratory Medicine, and the Department of Clinical Physiology, Skåne University Hospital, Malmö; Department of Rheumatology, Skåne University Hospital, Lund, Sweden.A.M. Nilsson, MD; E. Theander, MD, PhD; T. Mandl, MD, PhD, Department of Rheumatology; S. Diaz, MD, PhD; O. Ekberg, MD, PhD, Department of Radiology; E. Piitulainen, MD, PhD, Department of Respiratory Medicine, Skåne University Hospital, Malmö; R. Hesselstrand, MD, PhD, Department of Rheumatology, Skåne University Hospital, Lund; P. Wollmer, MD, PhD, Department of Clinical Physiology, Skåne University Hospital, Malmö
| | - Thomas Mandl
- From the Department of Rheumatology, Department of Radiology, Department of Respiratory Medicine, and the Department of Clinical Physiology, Skåne University Hospital, Malmö; Department of Rheumatology, Skåne University Hospital, Lund, Sweden.A.M. Nilsson, MD; E. Theander, MD, PhD; T. Mandl, MD, PhD, Department of Rheumatology; S. Diaz, MD, PhD; O. Ekberg, MD, PhD, Department of Radiology; E. Piitulainen, MD, PhD, Department of Respiratory Medicine, Skåne University Hospital, Malmö; R. Hesselstrand, MD, PhD, Department of Rheumatology, Skåne University Hospital, Lund; P. Wollmer, MD, PhD, Department of Clinical Physiology, Skåne University Hospital, Malmö
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