Radiological and Clinical Evaluation of Lung Involvement in Iraqi Patients with Systemic Lupus Erythematosus

Abstract

It is common for systemic lupus erythematosus (SLE) to affect the lungs, which can lead to moderate respiratory symptoms or severe restrictive lung disease. Pulmonary complications such as shrinking lung syndrome (SLS) are uncommon but significant from a clinical perspective. This study set out to answer several questions regarding SLE in Iraqi patients, including how common respiratory symptoms are, how often impaired pulmonary functioning, and what clinical and serological factors are associated with SLS in Baghdad Teaching Hospital in Baghdad, Iraq, was the site of the 2025 cross-sectional descriptive study. Eligible participants were adult patients who fulfilled the American College of Rheumatology (ACR) classification criteria for SLE. We collected demographic data, recorded clinical symptoms, and documented serologic markers. A chest X-ray or high-resolution computed tomography (HRCT) was ordered for all patients in addition to the pulmonary function tests (PFTs). Dyspnea, restricted lung physiology (Forced Vital Capacity (FVC) < 80% expected), and the absence of interstitial lung disease on x-rays were the diagnostic criteria for SLS. Patients exhibiting symptoms and radiographic interstitial alterations but no restrictive physiology served as controls. Of the 104 patients with SLE surveyed, 62 (59.6%) had respiratory symptoms, while 65 (65.4% of the total) had normal pulmonary function with abnormalities. The results showed that 9 patients had SLS (8.7). In a multivariate analysis where the length of the disease was controlled, a history of pleuritis, high American College of Rheumatology (ACR) clinical score, and seropositivity of anti-RNP antibodies were significantly associated with SLS. Longer illness duration, anti-RNP positive, and a history of serositivity were the independent predictors of SLS (OR = 1.18; 95% CI: 1.01132; p = 0.04). SLE patients from Iraq are more likely to experience respiratory symptoms, abnormal lung functions, and shrinking lung syndrome. When dealing with patients who have a history of pleuritis or who test positive for anti-RNP antibodies, clinicians should maintain a high suspicion for SLS. Timely diagnosis and treatment can lead to improved clinical outcomes.