South Korea: A large-scale Korean population-based longitudinal study has revealed that individuals with systemic lupus erythematosus (SLE) face a significantly higher risk of developing pulmonary complications. “SLE patients had a significantly higher risk of pulmonary complications than matched controls, with the highest risk observed for pulmonary hypertension (aHR 14.66) and interstitial lung disease (aHR 9.58). Overall, SLE was associated with a 3.3-fold increased risk, highlighting the importance of vigilant pulmonary monitoring in this population,” the researchers reported in RMD Open: Rheumatic & Musculoskeletal Diseases. SLE, a chronic autoimmune disorder, is known to affect multiple organ systems, including the lungs. While pulmonary complications are recognized in SLE, their precise risk and long-term impact have remained incompletely understood. To address this gap, Bo-Guen Kim, Kangbuk Samsung Hospital, Seoul, Korea (the Republic of), and colleagues aimed to assess the likelihood of pulmonary manifestations in individuals with SLE compared to matched controls. For this purpose, the researchers utilized data from the Korean National Health Insurance Service (2009–2017) to identify 6,074 individuals aged ≥20 years with newly diagnosed SLE. These patients were matched by age and sex (1:10 ratio) with 60,740 controls who had no prior pulmonary manifestations. The study
revealed the following findings:

Over a mean follow-up of 9.3±2.7 years, the
incidence of pulmonary manifestations was 15.2 per 1000 person-years in the SLE
cohort and 4.5 per 1000 person-years in the matched cohort.SLE patients had a significantly higher risk of
pulmonary manifestations (aHR 3.26).The highest risk was observed for pulmonary
hypertension (aHR 14.66).Interstitial lung disease had an elevated risk
(aHR 9.58).Pleural disorders were more common in the SLE
group (aHR 3.29).Pulmonary embolism risk was increased (aHR 2.66).SLE patients had a higher likelihood of
tuberculosis (aHR 2.35).Acute respiratory distress syndrome and
hemorrhage were more frequent (aHR 1.85).Lung cancer risk was also elevated (aHR 1.41).

The researchers acknowledged several limitations in their study. Diagnoses of SLE, pulmonary manifestations, and comorbidities were based on ICD-10 codes, which could lead to misclassification. To minimize this, they used both ICD-10 codes and the RID program registration code for SLE. The lack of serological and radiologic data limited the ability to assess factors such as autoantibodies, disease overlap, and the role of antiphospholipid syndrome in severe pulmonary complications. Additionally, since the study was based on a Korean dataset, further research on diverse populations is needed to validate these findings. Despite these limitations, the researchers concluded that SLE patients had an approximately 3.3-fold higher risk of pulmonary manifestations compared to matched controls, with particularly high risks for interstitial lung disease and pulmonary hypertension.Reference:Kim BG, Kim J, Eun Y, Park DW, Kim SH, Lee H. Comprehensive risk assessment for pulmonary manifestations in systemic lupus erythematosus: a large-scale Korean population-based longitudinal study. RMD Open. 2025 Feb 23;11(1):e005267. doi: 10.1136/rmdopen-2024-005267. PMID: 39988351.