Examination of the pulmonary findings of patients diagnosed with rheumatological disease who applied to the Pediatric Chest Diseases Polyclinic of Akdeniz University Faculty of Medicine with respiratory symptoms

Examination of the pulmonary findings of patients diagnosed with rheumatological disease who applied to the Pediatric Chest Diseases Polyclinic of Akdeniz University Faculty of Medicine with respiratory symptoms Introduction and purpose; Pediatric rheumatic diseases are a group of multisystemic chronic diseases, primarily of the musculoskeletal system, and are characterized by chronic inflammation. It is associated with many systemic complications, including pulmonary complications. However, lung involvement is an important risk for morbidity and mortality. rheumatic diseases; It may involve the lung parenchyma, pulmonary vessels, airways, respiratory muscles, pleura, and chest wall. Lung involvement may be simultaneous with the rheumatological disease, or it may sometimes precede the typical appearance of the disease. Clinical manifestations of pulmonary complications are highly variable and optimal treatment and follow-up principles are not well defined. However, pulmonary function tests, lung high-resolution computed tomography, bronchoscopy, bronchoalveolar lavage cytology and cultures, and lung biopsy are used to aid diagnosis. The aim of this study was to recognize pulmonary symptoms in children with rheumatic disease, to evaluate possible predictive radiological and laboratory findings in terms of progression to pulmonary involvement, and to determine which disease shows what type of pulmonary findings. Patients and methods; The files of children with a diagnosis of rheumatological disease who applied to the Pediatric Chest Diseases Polyclinic of the Akdeniz University Medical Faculty Hospital between 01.01.2014 and 31.12.2020 with respiratory system symptoms were analyzed retrospectively through the hospital electronic data system. Demographic, clinical, laboratory characteristics, other accompanying chronic diseases, imaging and pulmonary function test data, especially lung findings, of 80 patients included in the study were evaluated. The data of patients with and without radiologically detected lung findings, and the data of lung findings and pulmonary function test results among rheumatic diseases were compared. Results; Of 80 patients, 42 (52.5%) were female and 38 (47.5%) were male. The mean age was found to be 11,10±4,43 years. The mean duration of illness at the time of respiratory symptoms was found to be 34,73±53 months. There were 19 (23,8%) patients with active primary rheumatologic disease at the time of respiratory symptoms. JIA in 29 patients (36,3%), FMF in 26 patients (32,5%), SLE in 7 patients (8,8%), Behçet's disease in 7 patients (8,8%), other rheumatic diseases in 16 patients (20%) detected. Among the 4 most common rheumatological diseases, FMF was found to be the disease with the highest incidence of pathological findings with 82,4% in patients who underwent CT. The rates of those with pathological CT findings were 66,7% in SLE, 55,6% in JIA, and 40% in Behçet's disease. In 11 patients (13,8%), 90,9% of them were asthma and 9,1% of them were anthracosis, other accompanying chronic lung diseases were detected. Respiratory tract infection accompanied 21,2% of the patients. The most common presenting symptom was cough with a rate of 72,5%, and the most common respiratory examination finding was ral with a rate of 18,8%. Acute phase reactant elevation was detected in 40% of the patients at the time of admission. Pathological ECHO findings were observed in 13.5% of them. 71,1% of HRCT or thorax computed tomography results were found to be pathological. The most common finding on CT was a nodule with a rate of 26,9%, followed by mediastinal lymphadenopathy with a rate of 23%, an irregular density/infiltration rate of 21,2%, atelectasis of 17,3%, ground glass of 17.3%, a peribronchial thickening of 11.5%, a geographic pattern of 7,7%, and a geographic pattern of 5,7%. pleural effusion, pneumonia/consolidation, bronchiectasis, hilar lymphadenopathy, septal thickening were observed in 3,8%. The most common pattern in the PFT results of the patients was the restrictive pattern with a rate of 54,3%. 37,1% of the PFT results were found to be normal and 8,6% were found to be obstructive patterns. CT findings were compared between diseases, but no statistically significant difference was found. When the PFT findings of the patients with normal and pathological CT results were compared, the mean FEV1 and FVC values were found to be significantly lower in the group with pathological CT results. The FEV1/FVC ratio did not differ significantly between the two groups. It has been determined that the probability of a restrictive pattern is significantly higher in patients with FMF compared to those without FMF. In patients with Behçet's disease, the probability of observing an obstructive pattern in PFT results was found to be significantly higher than in patients without Behçet's disease. When laboratory findings were analyzed according to CT results, leukocyte count, absolute neutrophil count, and absolute monocyte count were found to be significantly lower in the group with pathological CT results compared to the group with normal CT results. When rheumatological parameters were analyzed according to CT results, the proportion of patients with a C4 value below 10 mg/dL was found to be significantly higher than those with normal CT results. The factors affecting the pathology of the CT result in patients with JIA were examined and no association was found with age, gender, smoking, systemic JIA diagnosis, place of residence, and medications used. Conclusion: Although pulmonary involvement due to pediatric rheumatic diseases is rare, it is very important in terms of morbidity and mortality. Evaluation of respiratory system findings of rheumatic diseases with spirometry and, if necessary, CT is important for early diagnosis of pulmonary involvement. Spirometry is a practical noninvasive evaluation method for the detection of pulmonary involvement of rheumatic diseases. Keywords: Pediatric rheumatic diseases, pulmonary involvement, HRCT, PFT