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Lung involvement in children with newly diagnosed rheumatic diseases: characteristics and associations
Hua Huang1, Yabin Hu2, Yufen Wu3
1Department of Rheumatology and Immunology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678, Dongfang RD., Pudong district, Shanghai, 200127, China.
Insights
Pediatric rheumatic diseases often involve the lungs, even without symptoms. Elevated erythrocyte sedimentation rate (ESR) and CD4/CD8 ratio indicate higher lung involvement risk in these children.
Area of Science:
- Pediatric Rheumatology
- Pulmonology
- Medical Imaging
Background:
- Pulmonary complications are a significant concern in rheumatic diseases, potentially leading to functional impairment and increased mortality.
- Limited data exists on lung involvement in treatment-naive, newly diagnosed pediatric rheumatic disease patients.
- This study characterizes lung involvement in this specific pediatric population.
Purpose of the Study:
- To describe the characteristics of lung involvement in children with newly diagnosed, treatment-naive rheumatic diseases.
- To explore the association between lung involvement and specific clinical and laboratory parameters in these patients.
Main Methods:
- Included 48 pediatric patients with treatment-naive rheumatic diseases and 51 age-matched healthy controls.
- Utilized pulmonary function tests (PFTs) and high-resolution computed tomography (HRCT) for patient assessment.
- Employed univariate and multivariable logistic regression to identify associated factors.
Main Results:
- 40% of patients showed decreased diffusing capacity of the lungs for carbon monoxide (DLCO) compared to controls.
- 31 (64.6%) patients exhibited lung involvement, with 56.3% having abnormal PFTs and 16.7% abnormal HRCT findings.
- Increased erythrocyte sedimentation rate (ESR) and CD4/CD8 ratio were significantly associated with lung involvement.
Conclusions:
- Pediatric patients with newly diagnosed rheumatic diseases frequently present with pulmonary involvement, often asymptomatic.
- Elevated ESR and CD4/CD8 ratio are key indicators associated with an increased risk of lung involvement.
- Routine pulmonary evaluation is recommended for all diagnosed rheumatic disease patients, particularly those with risk factors, irrespective of respiratory symptoms.
Background:
Pulmonary complications of rheumatic diseases may cause functional impairment and increase mortality. However, reports regarding detection of lung involvement in children with treatment-naive, newly diagnosed rheumatic diseases are scarce. Herein, we aimed to describe the characteristics of such patients and explore the association between lung involvement and rheumatic disease.
Methods:
From January 2019 to June 2021, 48 pediatric patients with treatment-naive, newly diagnosed rheumatic diseases at Department of Rheumatology and Immunology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University were included with pulmonary function tests (PFTs) and high-resolution computed tomography (HRCT) findings, and 51 age-matched healthy controls were examined based on PFTs. Univariate and multivariable logistic regression analyses were used to investigate the clinical characters and laboratory parameters associated with lung involvement in these patients.
Results:
Asymptomatic patients had a faster respiratory rate and a higher ratio of forced expiratory volume in 1 s/forced vital capacity than the controls (P < 0.05). More patients than controls were observed to have a decreased DLCO below the lower limit of normal (18 of 45 [40.0%] vs. 6 of 36, respectively; P = 0.041). Among the 48 patients, 8 (16.7%) had abnormal HRCT findings and 27 (56.3%) had abnormal PFT results. Thirty-one (64.6%) patients had lung involvement. Logistic regression revealed that increases in the erythrocyte sedimentation rate (ESR) and CD4/CD8 ratio were associated with increased odds ratio of lung involvement (1.037, 95% CI: 1.003-1.072; 9.875, 95% CI: 1.296-75.243, respectively).
Conclusions:
Pediatric patients with treatment-naive, newly diagnosed rheumatic diseases are prone to pulmonary involvement. Increased ESR and CD4/CD8 are associated with elevated odds of lung involvement in patients. We recommend routine pulmonary evaluation in such patients, especially in high-risk patients, even in the absence of respiratory symptoms, once they are diagnosed with rheumatic disease.
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