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Lupus erythematosus and respiratory

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  1. Summary
  2. Introduction
  3. Lupus pleurisy
  4. The acute lupus pneumonitis
  5. Alveolar hemorrhage
  6. The diffuse chronic interstitial pneumonia
  7. The reversible acute hypoxemia
  8. Diaphragmatic dysfunction
  9. Conclusions
  10. Bibliography

Most patients with systemic lupus erythematosus (SLE) have, during their illness, respiratory reached the most frequent is the pleurisy (one of the eleven diagnostic criteria recognized by the American Rheumatism Association). The respiratory events that found in the LED cover both the lung parenchyma as the pleura, the pulmonary vasculature, airways and respiratory muscles, and this alone or simultaneously. They may precede other manifestations of the LED or occur at any time during the disease. The clinical spectrum ranges from asymptomatic forms to attacks sometimes fatal. We must keep in mind that a pneumonia developing in a patient with lupus should mention first a trivial or opportunistic infection under a immunosuppressive treatment. This aspect will not be discussed in this manual, as well as pneumonia of drug.

[...] Five-year follow-up study of the prevalence and progression of pulmonary hypertension in systemic lupus erythematosus. Am Heart J 1995; 129: 510- Groen Bootsma Postma DS, Kallenberg CG. Primary pulmonary hypertension in a patient with systemic lupus erythematosus: Partial improvement with cyclophosphamide (see comments). J Rheumatol 1993; 20: 1055- Pin Fauchier Babuty Fauchier JP, Valat JP. Precapillary pulmonary hypertension dramatically improved with high doses of corticosteroids during systemic lupus erythematosus. J Rheumatol 1994; 21: 1976- Auger WR, Permpikul Moser KM. Lupus anticoagulant, heparin use, and thrombocytopenia in patients with chronic thromboembolic pulmonary hypertension: A preliminary report. [...]


[...] Pulmonary Hypertension The association between pulmonary hypertension (HTP) and LED has been known for decades and the prevalence was estimated at between 5 and 14%. However, the use of echocardiography combined with Doppler has allowed to better assess the prevalence of HTP. In a group of 36 patients with an LED and followed for five years, the prevalence of HTP (defined as systolic pulmonary artery pressure (PAPS)> 30 mmHg) increased from 14% initially to 43% at the end of follow-up. [...]


[...] The histological picture resembles that of acute lupus pneumonitis and may reveal a vasculitis of small arteries (microangéite) and pulmonary capillary (CAPILLARY) Deposits of C3, IgG and immune complexes are sometimes present in alveolar walls. Because of a certain analogy between lupus pneumonitis and alveolar hemorrhage, it is possible that these events represent two pulmonary expressions of the same inflammatory process alveolo-capillary. There is no randomized study defining a therapeutic strategy. Corticosteroids at high doses (pulses of methylprednisolone 0.5 g / day for 3-5 days, then prednisone at 1 mg / kg / represent the first line of treatment. [...]

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