Respiratory system involvement in systemic vasculitides.

Area of Science:

• Rheumatology
• Pulmonology
• Internal Medicine

Background:

• Systemic vasculitides (SV) can affect the respiratory system with varying frequency.
• Antineutrophil cytoplasmic antibodies-associated vasculitis (AASV), including Wegener's granulomatosis (WG), Churg-Strauss syndrome (CSS), and microscopic polyangiitis (MPA), commonly involve the lungs.

Purpose of the Study:

• To review the spectrum of respiratory system involvement in various types of SV.
• To highlight the clinical and radiological features of pulmonary manifestations in AASV and other SV.
• To emphasize the importance of respiratory assessment in SV patients.

Main Methods:

• Review of literature on respiratory involvement in systemic vasculitides.
• Analysis of clinical presentations and radiological findings in different SV subtypes.
• Discussion of diagnostic and prognostic implications of pulmonary manifestations.

Main Results:

• WG frequently presents with upper or lower respiratory tract disease, often showing nodules/masses on chest X-ray.
• CSS is characterized by asthma and allergic rhinitis, with patchy alveolar infiltrates on imaging.
• MPA commonly manifests as diffuse alveolar hemorrhage (DAH) due to alveolar capillaritis, presenting with hemoptysis and anemia.
• Respiratory involvement is less common in giant cell arteritis, Takayasu arteritis, and rare in other SV like polyarteritis nodosa.

Conclusions:

• Respiratory system involvement is a significant feature of AASV, with diverse clinical and radiological presentations.
• Pulmonary manifestations can have prognostic importance in SV.
• Respiratory assessment should be integral to the work-up of all SV patients, especially those with AASV.