Abstract
Introduction: Pulmonary involvement, such as Interstitial Lung Disease (ILD) and Pulmonary Hypertension
(PH ), accounts for significant morbidity and is the leading cause of Systemic sclerosis
(SSc)-related morbidity and mortality. The aim of the current study was to study the
frequency of occurrence of ILD in SSc and to describe the clinical and radiological
picture of pulmonary involvement in SSc. Patients and Methods: Forty patients attending different rheumatology clinics in eastern part of Libya
between January 2018 and September 2020 were included. Basic details including age,
gender, disease duration, detailed history, and clinical examination were noted. Autoimmune
profiling included rheumatoid factor, antinuclear antibodies, and anti-Scl-70 antibodies.
Pulmonary function test, chest X-ray (CXR), and high-resolution computed tomography
of the chest (HRCT) in all patients were recorded. Data presented either as frequencies
and percentages or as means ± standard deviation. Results: The male: female ratio was 1:9 with a mean age of 37.5 ± 9.6 years and duration of
illness 6 ± 4 years. diffuse cutaneous SSc was seen in 62.5% of the patients. 77.5%
of the participants had bilateral crepitation and 57.5% had loud P2. Presenting complaints
included gastrointestinal reflux in 72.5%, digitalis ulcerations in 40%, and synovitis/arthritis
of all patients. Other comorbidities included congestive heart failure in 12.5%, PH
in 15%, and renal impairments in 7.5% of all patients. Anti-Scl-70 antibody was the
most common in all patients (45%), followed by anti-centromere Ab (25%), anti-U3 RNP
(10%), and anti-U1 RNP (5%). 72.5% of the participants had reticulonodular shadows
on CXR. HRCT showed honeycombing as the predominant finding (37.5%). Echocardiograms
showed that 15% of all patients have signs of PH. Duration of disease, dyspnea, cough,
bilateral crepitations, and CXR were found to be significantly associated with extensive
ILD (P < 0.05). Conclusion: ILD is a serious complication of SSc, it is more common among patients with dcSSc.
Chest HRCT is very sensitive to detect ILD. A significant association was found in
Libyan patients between the severity of ILD and the duration of disease, dyspnea,
cough, bilateral crepts, and CXR.
Key-words:
Interstitial lung disease - Libya - systemic sclerosis