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Exhaled nitric oxide, pulmonary function, and disease activity in children with systemic lupus erythematosus
Jitladda Deerojanawong1, Pitchaya Leartphichalak1, Ankanee Chanakul1
1Faculty of Medicine, Department of Pediatrics, Chulalongkorn University, Bangkok, Thailand.
Insights
Fractional exhaled nitric oxide (FENO) and decreased total lung capacity (TLC) are common in children with systemic lupus erythematosus (SLE) and correlate with disease activity. FENO can aid in assessing SLE disease activity in pediatric patients.
Area of Science:
- Pediatric Rheumatology
- Pulmonology
- Biomarkers
Background:
- Systemic lupus erythematosus (SLE) can affect multiple organ systems, including the lungs.
- Pulmonary involvement in pediatric SLE is not always clinically apparent.
- Identifying reliable markers for disease activity is crucial for managing pediatric SLE.
Purpose of the Study:
- To investigate the association between fractional exhaled nitric oxide (FENO), pulmonary function, and disease activity in children diagnosed with SLE.
- To determine if FENO can serve as a non-invasive marker for disease activity in pediatric SLE.
Main Methods:
- Children aged 7-18 years with SLE were enrolled and assessed for disease activity, FENO levels, and pulmonary function.
- Evaluations were conducted at baseline and a 6-month follow-up.
- Statistical analyses were performed to identify correlations between FENO, pulmonary function parameters (including total lung capacity - TLC), and SLE disease activity.
Main Results:
- Twenty-four children with SLE were studied; most were female with a mean age of 15.2 years.
- Abnormal pulmonary function, primarily restrictive defects, was observed in 20.8% at baseline, increasing to 29.2% at follow-up.
- A significant positive correlation was found between FENO and SLE disease activity (r=0.49, P=0.02).
- A significant negative correlation was detected between TLC and disease activity in active SLE cases (r=-0.71, P=0.02).
Conclusions:
- Elevated FENO and reduced TLC are prevalent in pediatric SLE patients, even without respiratory symptoms.
- FENO levels correlate with SLE disease activity.
- FENO represents a valuable additional tool for evaluating disease activity in children with SLE.
Aim:
To determine the association among fractional exhaled nitric oxide (FENO), pulmonary function, and disease activity in children with systemic lupus erythematosus (SLE).
Methods:
Children aged 7-18 years, diagnosed with SLE under the criteria of the American Rheumatism Association (revised 2012), were enrolled. All eligible participants had disease activity, FENO, and pulmonary function evaluated and re-evaluated at 6-month follow-up.
Results:
Twenty-four children (95.8% female; mean age 15.2 ± 2 years; median disease duration 2.4 years) were studied. The mean FENO1 and FENO2 were 19.6 ± 7.2 parts per billion (ppb) and 17.4 ± 4.5 ppb, respectively. At baseline, 20.8% had abnormal pulmonary functions (all restrictive defects) and increased to 29.2% at follow-up (isolated restrictive defect 25% and restrictive with diffusion defect 4.2%). Most of their disease activities at baseline and second assessment were non-active (58.3%, 70.8%) or mild disease activities (20.8% both). There was significant correlation between FENO and disease activity (r = 0.49; P-value = 0.02). The significant negative correlation between total lung capacity (TLC) and disease activity was detected in children with active SLE (r = -0.71; P-value = 0.02).
Conclusion:
Decreased TLC and high FENO were common in SLE children who had no respiratory symptoms and correlated with disease activity. FENO should be considered as an additional pulmonary function to evaluate disease activity in children with SLE.
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