Predictive Factors for Pneumomediastinum During Management of Connective Tissue Disease-related Interstitial Lung Disease: A Retrospective Study

Okamoto, Susumu; Tsuboi, Hiroto; Noma, Hisashi; Tabuchi, Daiki; Sugita, Takahisa; Nishiyama, Taihei; Terasaki, Toshihiko; Shimizu, Masaru; Honda, Fumika; Yagishita, Mizuki; Ohyama, Ayako; Kurata, Izumi; Abe, Saori; Takahashi, Hiroyuki; Osada, Akira; Hagiwara, Shinji; Kondo, Yuya; Matsumoto, Isao; Sumida, Takayuki

doi:10.2169/internalmedicine.6892-20

Cited by 6 publications

(8 citation statements)

References 51 publications

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“…Serum LDH is a traditional biomarker for ILD, 39 and LDH levels are positively correlated with CTD-ILD activity or severity. 40 In our study, serum LDH level was higher in the lung-onset group (p = .018), and was negatively correlated with TCL (%pred). In addition, hypoproteinemia was a risk factor for the progression of ILD and an independent risk factor for mortality in pSS-ILD patients.…”

Section: Discussionsupporting

confidence: 49%

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The characteristics of chest HRCT and pulmonary function tests in lung‐onset primary sjogren's syndrome

Dong

Gao

et al. 2023

Immunity Inflam & Disease

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IntroductionInterstitial lung disease (ILD) can manifest before the diagnosis of primary Sjögren's syndrome (pSS), however, the underlying mechanisms remain unclear. The aim of this study is to investigate the characteristics of lung‐onset pSS using chest high‐resolution computerized tomography (HRCT) and pulmonary function tests (PFTs).MethodsThe data of 102 patients with pSS‐ILD were retrospectively analyzed. The patients were divided into two groups: lung‐onset group and the nonlung‐onset group. The chest HRCT, PFTs, and clinical and laboratory data were evaluated and compared.ResultsAmong the 102 patients with pSS‐ILD, 59 (57.8%) were lung‐onset and 43 (42.2%) were nonlung‐onset. Chest HRCT in the lung‐onset group showed higher percentage of usual interstitial pneumonia and nonspecific interstitial pneumonia, the difference did not reach statistical significance. The total HRCT score was higher in the lung‐onset group, compared with the nonlung‐onset group (2 [2, 3], vs. 2 [1, 2], p = .014). Total lung capacity (TLC) (%pred) [(75.4 ± 16.2) versus (82.8 ± 19.4), p = .049] and forced vital capacity (FVC) (%pred) [(82.2 ± 19.9) versus (91.6 ± 28.3), p = .050] were significantly lower in the lung‐onset group, compared with the nonlung‐onset group. Residual volume (RV)/TLC (%) significantly increased more than 40% in the lung‐onset group (p = .015). Restricted ventilation disorder, small airway obstruction and reduced diffusing capacity of the lung for carbon monoxide/alveolar volume (%Pred) were more common in the lung‐onset group (p = .038, p = .050, and p = .050, respectively). Correlation analysis showed that HRCT score was positively correlated with the interval between the onset of pulmonary symptoms and the diagnosis of ILD, serum CA125, and serum CEA. TCL (%pred), VC (%pred), FVC (%pred) were negatively correlated with serum CA125.ConclusionLung‐onset is common in pSS patients with more severe lung function impairments. Serum biomarkers, such CA125, CEA, and ALB, were associated with the severity of lung damage.

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Section: Discussionsupporting

confidence: 49%

“…Serum LDH is a traditional biomarker for ILD, 39 and LDH levels are positively correlated with CTD‐ILD activity or severity 40 . In our study, serum LDH level was higher in the lung‐onset group ( p = .018), and was negatively correlated with TCL (%pred).…”

Section: Discussionmentioning

confidence: 46%

The characteristics of chest HRCT and pulmonary function tests in lung‐onset primary sjogren's syndrome

Dong

Gao

et al. 2023

Immunity Inflam & Disease

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“…In a retrospective analysis, the clinical comparison between patients with CTD-related ILD who developed pneumomediastinum after the initiation of corticosteroid therapy and those who did not identified steroids as a risk factor for the development of pulmonary air leak especially if combined with major predictive factors such as low body mass index (BMI) and high serum lactate dehydrogenase (LDH) levels. 23 …”

Section: Discussionmentioning

confidence: 99%

“…21,22 In a retrospective analysis, the clinical comparison between patients with CTD-related ILD who developed pneumomediastinum after the initiation of corticosteroid therapy and those who did not identified steroids as a risk factor for the development of pulmonary air leak especially if combined with major predictive factors such as low body mass index (BMI) and high serum lactate dehydrogenase (LDH) levels. 23 Probable lesions of pulmonary vasculitis and underlying interstitial lesions such as centrilobular and sub-pleural 'pseudo blebs' subsequent to cystic degeneration of fibrotic lesions or to excavation of rheumatoid nodules have also been incriminated. 3 Different modalities are used for air leak diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary air leak syndrome in rheumatoid arthritis patient

Ouali

Chorfa

Hamzaoui

et al. 2022

SAGE Open Medical Case Reports

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Pulmonary air leak syndromes involve dissection of air out of the normal pulmonary airspaces and include pulmonary interstitial emphysema, pneumothorax, pneumomediastinum, pneumopericardium, pneumoperitoneum, subcutaneous emphysema and systemic air embolism. It presents as a spontaneous extension of dissecting air without a history of a procedure or penetrating injury. Pulmonary air leak syndromes are extremely rare complications of systemic autoimmune connective tissue diseases. Few cases were reported in the literature regarding rheumatoid arthritis patients. The purpose of this article is to emphasize on this rare pulmonary complication and discuss the physiopathology of the disease and the different risk factors for a better management of these patients. We report the case of a 45-year-old female, with a history of proven rheumatoid arthritis under methotrexate and steroids, who presented with a spontaneous dissecting subcutaneous emphysema, pneumothorax, pneumomediastinum and pneumoperitoneum. The patient’s condition improved after chest drainage and adjustment of her medical treatment.

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“…Theoretically, glucocorticoids may weaken the pulmonary interstitium by affecting protein metabolism. But a study found that intravenous methylprednisolone pulse therapy was not a predictor of the development of PNM in CTDs ( 34 ). But more study on PNM in MDA5 + DM is scarce.…”

Section: Pnm and Mda5 + Dmmentioning

confidence: 99%

Rare complications of anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis: Time to nip them in the bud

Yang

Yan

2022

Front. Immunol.

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Anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis (MDA5+ DM) is an infrequent autoimmune disease, which mainly distributes in Asians and females. MDA5+ DM usually presents various skin lesions and positive anti-MDA5 antibody (a myositis-specific autoantibody for itself) with amyopathic or hypomyopathic features. For MDA5+ DM patients, rapidly progressive interstitial lung disease is a common complication with a high-speed deterioration and a poor prognosis. Besides, there are other complications of MDA5+ DM patients, including pneumomediastinum, macrophage activation syndrome and spontaneous intramuscular hemorrhage. These complications were rare but lethal, so it is necessary to explore their diagnosis methods, therapies and potential mechanisms, which are helpful for early diagnoses and timely treatment. To date, several cases and studies have shown distinctive features, diagnoses and treatments of these three rare complications, and there are also some differences among them. In this review, we outlined the characteristics, administration and potential pathogenesis of these rare complications of MDA5+ DM.

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Predictive Factors for Pneumomediastinum During Management of Connective Tissue Disease-related Interstitial Lung Disease: A Retrospective Study

Cited by 6 publications

References 51 publications

The characteristics of chest HRCT and pulmonary function tests in lung‐onset primary sjogren's syndrome

The characteristics of chest HRCT and pulmonary function tests in lung‐onset primary sjogren's syndrome

Pulmonary air leak syndrome in rheumatoid arthritis patient

Rare complications of anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis: Time to nip them in the bud

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