Pulmonary Involvement in Systemic Sclerosis: An Imaging Study from Kashmir

BACKGROUND: Systemic sclerosis (SS) is a chronic, multisystem collagen vascular disorder of undefined etiology, whose prognosis and overall survival is determined by visceral especially the lung involvement. AIM: To evaluate the pulmonary involvement in SS by imaging methods. MATERIALS AND METHODS: Clinical examination, pulmonary function tests, chest X-ray and high resolution computed tomography (HRCT) scans were carried out in a series of 25 patients prospectively over a period of 3 years (2009-2011AD). RESULTS: Of the total 25 patients of the study, the group with abnormal HRCT chest (n = 20), 16 had clinical symptoms of respiratory involvement, only 7 had an abnormal chest X-ray and 15 had abnormal forced expiratory volume/forced vital capacity (FEV1/FVC) spirometric parameter. While the group with normal HRCT chest (n = 5), 1 had clinical symptoms of respiratory involvement and 4 had abnormal FEV1/FVC spirometric parameter. The differences in these parameters between the two groups were statistically significant, while the differences for mean skin tethering index, mean disease duration and female/male sex ratio were statistically meaningless. Most common HRCT finding observed in the study was ground glass opacities (GGO) (9/20). Only 4 of total 9 patients who had only GGO in HRCT were symptomatic for respiratory involvement as compared to 100% (11/11) in the group who had HRCT findings other than or in addition to GGO. CONCLUSION: The HRCT outscores Chest X-ray in detecting early lung involvement in SS patients more so early in the course of the disease thereby underscoring its importance in identifying SS patients who will be potential candidates for early institution of therapy that might reverse/limit pulmonary involvement by the disease.