Retrospective cohort study identifying pulmonary complications in a cohort of patients with systemic lupus erythematosus

Background Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with multi organ involvement. One of the most common manifestations is pulmonary disease with a reported prevalence between 5%–90%. Purpose Given this wide range of prevalence, there is a need to more closely define types of pulmonary disease in SLE and associated risk factors. Research Design We sought to characterize the presentation of pulmonary manifestations in an established SLE cohort using electronic health record data. Study Sample All patients were >18 years of age and had confirmed SLE by a rheumatologist using SLICC or 2019 ACR/EULAR classification criteria. 220 patients with imaging were included in this study; average age was 42.5 years, 86.7% identified as female, 60.5% identified as white, 37.3% as Black, and 1.82% as Asian. Analysis Generalized estimating equations were utilized to analyze the data, accounting for its repeated measured nature. Results We found an association between smoking (present/prior smoker) and radiologist reported disease on computerized tomography (CT) scan, as well as an association between smoking (present/prior smoker), older age, and male sex with having pulmonary disease identified on chest X-ray. The most common findings on CT and X-ray were increased lung density (24%, 12%) and atelectasis (18%, 10%). The most common disease found on CT was pleural effusion (24%) and mediastinal/axillary lymphadenopathy (16%). Conclusion While our study is limited by the retrospective nature, our results show that certain factors, namely smoking, older age, or male sex should prompt clinicians to have a higher suspicion for lung disease in SLE patients.