This systematic review and meta-analysis of 40 observational studies estimated the pooled prevalence of major pulmonary complications in SLE patients, including ILD (radiographic and clinical), PAH, DAH, shrinking lung syndrome, and acute lupus pneumonitis.
Radiographic interstitial lung abnormalities (ILA) were found in 12.39% of SLE patients (95% CI: 9.68–15.36%), while clinical ILD prevalence was 2.92% (95% CI: 1.50–4.46%). Among SLE-ILD cases, NSIP was the dominant pattern (52.47%), followed by UIP (12.09%). PAH occurred in 2.30%, lupus pneumonitis in 3.05%, DAH in 1.37%, and shrinking lung syndrome in 1.25% of SLE patients.
Pooled data come from heterogeneous observational studies (both prospective and retrospective), which may vary in diagnostic criteria and imaging protocols. Confidence intervals for rarer complications (e.g., SLS, DAH) are wide, reflecting sparse data. Publication bias and variable definitions of ILD/ILA across studies may affect prevalence estimates.
Pulmonary complications in SLE—especially subclinical ILD—are more common than widely appreciated; clinicians should consider targeted HRCT screening for ILD and right heart catheterization for PAH in high-risk or symptomatic SLE patients. DAH, shrinking lung syndrome, and lupus pneumonitis remain rare but warrant vigilance.
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