Restricted accessBrief reportFirst published online 2026-2
Prevalence of pulmonary diseases among patients newly diagnosed with systemic lupus erythematosus: A cross-sectional case-series introducing thoracic ultrasound and diaphragmatic ultrasound
Pulmonary diseases (PD) are common in Systemic Lupus Erythematosus (SLE) and associated with increased mortality and decreased health-related quality of life, but no study has so far addressed PD in newly diagnosed patients with SLE. Our objectives were among newly diagnosed patients with SLE to investigate: Primarily, if PD and subtypes of PD are present, and secondarily characterise the patients by means of (i) lung physiology, (ii) radiology, (iii) thoracic ultrasound (TUS) and diaphragmatic ultrasound (DUS).
Methods
Patients newly diagnosed with SLE from 1st July 2023 to 31st July 2024 at Odense University Hospital, Odense, Denmark, underwent a dedicated clinical evaluation for PD, including pulmonary function tests (PFT), chest high-resolution computed tomography or computed tomography scan alongside with TUS and DUS. Subsequently, PD were diagnosed, and subtype was categorised on a multidisciplinary discussion.
Results
Ten participants were included in average 3 months after SLE diagnosis, and six out of ten had PD. PD included one case of shrinking lung syndrome (SLS) and two cases of interstitial lung disease. All participants exhibited at least one abnormal PFT measure, with some showing severely reduced pulmonary function. TUS was associated with diseases of the lung parenchyma and pleura and DUS with SLS.
Conclusion
We found PD among newly diagnosed patients with SLE and in some cases associated with severely affected pulmonary function. TUS and DUS may contribute with information in diagnosing SLE related PD, but further studies are needed.
NarváezJBorrellHSánchez-AlonsoF, et al.Primary respiratory disease in patients with systemic lupus erythematosus: data from the Spanish rheumatology society lupus registry (RELESSER) cohort. Arthritis Res Ther2018; 20(1): 280.
4.
OsmanHMAbdel-NasserAMKasemAH, et al.Pulmonary involvement: a potential independent factor for quality of life in systemic lupus erythematosus. Lupus2023; 32(2): 198–206.
5.
TraynorAECorbridgeTCEaganAE, et al.Prevalence and reversibility of pulmonary dysfunction in refractory systemic lupus: improvement correlates with disease remission following hematopoietic stem cell transplantation. Chest2005; 127(5): 1680–1689.
6.
DuronLCohen-AubartFDiotE, et al.Shrinking lung syndrome associated with systemic lupus erythematosus: a multicenter collaborative study of 15 new cases and a review of the 155 cases in the literature focusing on treatment response and long-term outcomes. Autoimmun Rev2016; 15(10): 994–1000.
7.
AndonopoulosAPConstantopoulosSHGalanopoulouV, et al.Pulmonary function of nonsmoking patients with systemic lupus erythematosus. Chest1988; 94(2): 312–315.
8.
TamerAGheitaSE-MFawzySM, et al.Shrinking lung syndrome in systemic lupus erythematosus patients with dyspnea. The Egyptian Rheumatologist2012; 34: 179–183.
9.
ŞenkalNKıyanEDemirAA, et al.Interstitial lung disease in patients with systemic lupus erythematosus: a cohort study. Turk J Med Sci2022; 52(1): 76–82.
10.
AllenDFischerABshoutyZ, et al.Evaluating systemic lupus erythematosus patients for lung involvement. Lupus2012; 21(12): 1316–1325.
11.
HishamMHabibWRAMohamedM, et al.Pulmonary involvement in early systemic lupus erythematosus. The Egyptian Rheumatologist2013; 35: 225–231.
12.
XieHQZhangWWSunS, et al.A simplified lung ultrasound for the diagnosis of interstitial lung disease in connective tissue disease: a meta-analysis. Arthritis Res Ther2019; 21(1): 93.
13.
OtaolaMDavidsenJR. Lung ultrasound as a screening tool for interstitial lung disease in patients with rheumatoid arthritis: state of the art. Curr Opin Pulm Med2025; 31(5): 476–483.
14.
Pinal-FernandezIPallisa-NuñezESelva-O'CallaghanA, et al.Pleural irregularity, a new ultrasound sign for the study of interstitial lung disease in systemic sclerosis and antisynthetase syndrome. Clin Exp Rheumatol2015; 33(4 Suppl 91): S136–S141.
15.
SatışHCindilESalmanRB, et al.Diaphragmatic muscle thickness and diaphragmatic function are reduced in patients with systemic lupus erythematosus compared to those with primary sjögren's syndrome. Lupus2020; 29(7): 715–720.
16.
von ElmEAltmanDGEggerM, et al.Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Bmj2007; 335(7624): 806–808.
17.
FriesJFHolmanHR. Systemic lupus erythematosus: a clinical analysis. Major Probl Intern Med1975; 6: 199.
18.
AringerMCostenbaderKDaikhD, et al.2019 european league against rheumatism/American college of rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis2019; 78(9): 1151–1159.
GladmanDGinzlerEGoldsmithC, et al.The development and initial validation of the systemic lupus international collaborating clinics/American college of rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum1996; 39(3): 363–369.
21.
ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med2002; 166(1): 111–117.
22.
GrahamBLBrusascoVBurgosF, et al.2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung. Eur Respir J2017; 49(1): 1600016.
23.
GrahamBLSteenbruggenIMillerMR, et al.Standardization of spirometry 2019 update. An official American thoracic society and European respiratory society technical statement. Am J Respir Crit Care Med2019; 200(8): e70–e88.
24.
BhaktaNRMcGowanARamseyKA, et al.European respiratory society/American thoracic society technical statement: standardisation of the measurement of lung volumes, 2023 update. Eur Respir J2023; 62(4): 2201519.
25.
FletcherCM. The clinical diagnosis of pulmonary emphysema; an experimental study. Proc Roy Soc Med1952; 45(9): 577–584.
YaoXYLiHMSunBW, et al.Ultrasound assessment of diaphragmatic dysfunction in non-critically ill patients: relevant indicators and update. Front Med2024; 11: 1389040.
28.
BoussugesAGoleYBlancP. Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest2009; 135(2): 391–400.
29.
MatamisDSoilemeziETsagouriasM, et al.Sonographic evaluation of the diaphragm in critically ill patients. Technique and clinical applications. Intensive Care Med2013; 39(5): 801–810.
30.
HatabuHHunninghakeGMRicheldiL, et al.Interstitial lung abnormalities detected incidentally on CT: a position paper from the fleischner society. Lancet Respir Med2020; 8(7): 726–737.
31.
MittooSFellCD. Pulmonary manifestations of systemic lupus erythematosus. Semin Respir Crit Care Med2014; 35(2): 249–254.
32.
GheitaTAAzkalanyGSEl-FishawyHS, et al.Shrinking lung syndrome in systemic lupus erythematosus patients; clinical characteristics, disease activity and damage. Int J Rheum Dis2011; 14(4): 361–368.
33.
JoyGMArbivOAWongCK, et al.Prevalence, imaging patterns and risk factors of interstitial lung disease in connective tissue disease: a systematic review and meta-analysis. Eur Respir Rev2023; 32(167): 220210.
34.
FidlerLKeenKJToumaZ, et al.Impact of pulmonary disease on patient-reported outcomes and patient-performed functional testing in systemic lupus erythematosus. Lupus2016; 25(9): 1004–1111.
35.
GibsonCJEdmondsJPHughesGR. Diaphragm function and lung involvement in systemic lupus erythematosus. Am J Med1977; 63(6): 926–932.
36.
EvansSAHopkinsonNDKinnearWJ, et al.Respiratory disease in systemic lupus erythematosus: correlation with results of laboratory tests and histological appearance of muscle biopsy specimens. Thorax1992; 47(11): 957–960.
37.
Le TallecEBourgCBouzilléG, et al.Prognostic value and predictors of the alteration of the diffusing capacity of the lungs for carbon monoxide in systemic lupus erythematosus. Rheumatology2024; 63(8): 2178–2188.
38.
RazaANadeemNCardilloC, et al.Busting the myths of DLco for pulmonary trainees: isolated reductions in DLco and the relationship with VA. JoR2025; 5(3): 8.
39.
BergkampSCWahadatMJSalahA, et al.Dysregulated endothelial cell markers in systemic lupus erythematosus: a systematic review and meta-analysis. J Inflamm2023; 20(1): 18.
40.
AlfaroEDíaz-GarcíaEGarcía-TovarS, et al.Endothelial dysfunction and persistent inflammation in severe post-COVID-19 patients: implications for gas exchange. BMC Med2024; 22(1): 242.
41.
FigueiredoRGDuarteNFVCamposDCB, et al.Improving accessibility to patients with interstitial lung disease (ILD): barriers to early diagnosis and timely treatment in Latin America. Int J Environ Res Publ Health2024; 21(5): 647.
42.
AbuzaidM. Optimizing radiation dose in high-resolution chest CT: the impact of patient-specific factors and size-specific dose estimates. Diagnostics2025; 15(6): 740.
43.
SariFOskayDTufanA. The effect of respiratory muscle training on respiratory muscle strength, diaphragm thickness/mobility, and exercise capacity in patients with systemic lupus erythematosus and associated shrinking lung syndrome. Lupus2024; 3: 9612033241226755.
44.
MedlinJLHansenKEMcCoySS, et al.Pulmonary manifestations in late versus early systemic lupus erythematosus: a systematic review and meta-analysis. Semin Arthritis Rheum2018; 48(2): 198–204.
45.
TravisWDCostabelUHansellDM, et al.An official American thoracic society/European respiratory society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med2013; 188(6): 733–748.
46.
ReesFDohertyMGraingeMJ, et al.The worldwide incidence and prevalence of systemic lupus erythematosus: a systematic review of epidemiological studies. Rheumatology2017; 56(11): 1945–1961.
47.
BoodhooKDLiuSZuoX. Impact of sex disparities on the clinical manifestations in patients with systemic lupus erythematosus: a systematic review and meta-analysis. Medicine (Baltim)2016; 95(29): e4272.
48.
PolverinoEGoeminnePCMcDonnellMJ, et al.European respiratory society guidelines for the management of adult bronchiectasis. Eur Respir J2017; 50(3): 1700629.
49.
FanouriakisAKostopoulouMAlunnoA, et al.2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis2019; 78(6): 736–745.
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