Methotrexate Lung Complications
Pulmonary Veno-Occlusive Disease
Restrictive Lung Disease
Shrinking Lung Syndrome
Systemic sclerosis (scleroderma) can affect the skin and/or internal organs. One of the ways scleroderma can affect the lungs is by causing pulmonary fibrosis, which is a scarring of the lungs. Lung involvement is the second most common complication of systemic scleroderma, eventually occurring in about 70%, and, unfortunately, it is the most common cause of death.
Systemic sclerosis (scleroderma)—such as limited scleroderma, CREST, or diffuse scleroderma—can cause lung problems which may include aspiration pneumonia, lung abscesses, pleural effusions, pulmonary fibrosis, pulmonary hypertension and shrinking lung syndrome.
Lung involvement of all types can occur alone, or as part of other illnesses, or, much less commonly, as a manifestation of scleroderma.
Unfortunately, systemic scleroderma is often not detected or diagnosed until the last stages of lung involvement, particularly in those who have not developed the overt and classic sign of scleroderma skin hardening, which is known as sclerodactyly. See ISN's free online PDF brochure "What is Scleroderma?" which includes a Systemic Scleroderma Symptom Checklist.)
Evaluation and management approaches for scleroderma lung disease. Extensive research has also led to an improved understanding of the mediators involved in the pathogenesis of interstitial lung disease and pulmonary hypertension. PubMed, Ther Adv Respir Dis, 2017 Aug;11(8):327-340.
Shortness of Breath This worrisome symptom has many acute and chronic causes. Follow this flowchart for more information about the diseases in which shortness of breath occurs. familydoctor.org
Chest Pain, Chronic Many different types of problems can cause discomfort, shortness of breath, pain with swallowing, and many other symptoms in the chest area. This chart may help you pinpoint your problem as you confirm your symptoms. familydoctor.org
Tests for Pulmonary Involvement
|Diagnosis of Pulmonary Fibrosis
Diagnosis of Pulmonary Hypertension
Predictors of Morbidity and Mortality
|Health Related Quality of Life Issues (HRQOL)|
Clinicopathological characteristics of lung cancer in patients with systemic sclerosis (SSc). A high proportion of patients had SSc-interstitial lung disease, including non specific interstitial pneumonia and usual interstitial pneumonia. PubMed, Clin Respir J, 08/08/2020. (Also see Cancer)
Clinical characteristics of autoimmune rheumatic disease–related organizing pneumonia (AIRD–OP). Compared with cryptogenic organizing pneumonia patients, AIRD–OP patients are characterized with occult onset but more severe lung involvement and higher recurrence rate. PubMed, Clin Rheumatol, 2018 Apr;37(4):1027-1035.
Aspiration pneumonia occurs when vomitus or reflux gets into the lungs, causing an often deadly form of pneumonia. ISN.
Correlation with Lung Involvement
A systematically derived exposure assessment instrument for Chronic Hypersensitivity Pneumonitis (CHP). This Delphi survey provides items that interstitial lung disease experts agree are important to ask in all patients presenting with suspected CHP and provides basis for a systematically derived CHP exposure assessment instrument. PubMed, Chest, 01/17/2020.
Solitary organizing pneumonia (SOP) in systemic sclerosis (SSc) mimicking lung adenocarcinoma. SOP is often misdiagnosed and removed surgically as it is rare and difficult to distinguish from lung carcinoma. SOP should be considered when a solitary nodular lung lesion is noted in a patient with SSc. PubMed, Arthritis Rheumatol. (Also see Cancer and Scleroderma)
Scleroderma and Cancer. Systemic sclerosis (scleroderma) may be associated with an increased incidence of cancer, including breast cancer, B-cell lymphoma, lung cancer and tongue cancer. ISN.
Gastrointestinal Tract Cancer
Malignant Atrophic Papulosis/Degos
|Medications and Cancer
Myeloma (Bone Marrow Cancer)
T Cell Lymphoma
Tongue and Oral Cancer
|Overview of Oxygen Therapy
Dangers of Oxygen and Flame
Custom Oxygen Tank Covers and Cases
|Oxy View Glasses
Related Patient Stories
Pleural Effusion is fluid in the lining of the lungs. In scleroderma, this is usually caused by inflammation (rather than infection.) ISN.
Pulmonary (Lung) Fibrosis is a scarring of the lungs, and is the consequence of untreated pulmonary inflammation (alveolitis). ISN.
Pulmonary Hypertension (PH) is high blood pressure in the arteries which take blood between the heart and lungs. ISN.
Exercised Induced PH
Pulmonary veno-occlusive disease is an extremely rare form of high blood pressure in the lung arteries. MedLine Plus.
Poor scleroderma-pulmonary hypertension-interstitial lung disease (SSc-PH-ILD) Prognosis May be Linked to Pulmonary Veno-occlusive Disease (PVOD). A high prevalence of PVOD SSc patients with pulmonary hypertension associated with interstitial lung disease may explain the poor prognosis observed in this patient group, according to a new study. Scleroderma News, 03/19/2019.
Restrictive Lung Disease. Restrictive lung diseases are characterized by reduced lung volume, either because of an alteration in lung parenchyma or because of a disease of the pleura, chest wall, or neuromuscular apparatus. In physiological terms, restrictive lung diseases are characterized by reduced total lung capacity (TLC), vital capacity, or resting lung volume. Medscape.
Shrinking lung syndrome and systemic autoimmune disease. Shrinking lung syndrome is rare but must be considered in patients with autoimmune disease and dyspnea. The diagnosis can be difficult because of clinical, pathological and functional features which are controversial. PubMed, Rev Med Interne.
Case Report: Systemic lupus erythematosus (SLE) presenting as severe alveolar hypoventilation and the shrinking lung syndrome (SLS). The interesting features of this case report consist of the presentation of the SLS as an alveolar hypoventilation with a fatal outcome and the presentation of systemic lupus as SLS. PubMed, Rev Mal Respir. (Also see Symptoms and Complications of Lupus)
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