Lung Abnormalities in Systemic Sclerosis Patients through Spirometry, Chest X-Ray, and High-Resolution Computed Tomography Scan

Sumartini Dewi, Waliyyuddin Robbani, Iceu Dimas Kulsum


Background: Systemic sclerosis (SSc) is a multisystem autoimmune illness with  a wide range of clinical symptoms. The pulmonary organ manifestations  frequently occur, but the symptoms are non-specific. Radiological examination and pulmonary function tests (spirometry) are needed to detect lung abnormalities in SSc patients. This study aimed to obtain information about the overview of lung abnormalities in SSc patients through spirometry, chest x-ray, and high-resolution computed tomography (HRCT) scan examination.

Methods: A descriptive qualitative study was conducted on 75 SSc patients registered in Dr. Hasan Sadikin General Hospital Bandung from January 2019 to December 2020. Data were collected with a total sampling method and presented in proportions and percentages.

Results: The majority of subjects were affected by cutaneous 73 (97%), pulmonary 29 (39%), and musculoskeletal 17 (23%) involvement. Spirometry revealed that 43 subjects (57%) had restrictive lung disease, with one false-positive case and two false-negative cases. On a chest x-ray, 45 (60%) of subjects had abnormalities. The majority of subjects were found to have Ground-glass opacities on HRCT scans. Ground-glass opacities were discovered in 46 subjects (82%) and 27 subjects (60%) were identified as having severe fibrosis scores.

Conclusion: According to spirometry results and abnormalities on chest x-ray and HRCT scans, the majority of SSc patients have restrictive lung disease.


Chest X-ray, HRCT scan, interstitial lung disease, sclerosis systemic, spirometry

Full Text:



Kasper D, Fauci A, Longo D, Hauser S, Jameson J, Loscalzo J. Harrison’s principles of internal medicine. 19th ed. New York: McGraw-Hill; 2015. p. 2154–5.

Dewi S, Isbagio H, Purwaningsih EH, Kertia N, Setiabudy R, Setiati S. A double-blind, randomized controlled trial of ciplukan (physalis angulata Linn) extract on skin fibrosis, inflammatory, immunology, and fibrosis biomarkers in scleroderma patients. Acta Med Indones. 2019;51(4):303–10.

Fett N. Scleroderma: nomenclature, etiology, pathogenesis, prognosis, and treatments: facts and controversies. Clin Dermatol. 2013;31(4):432–7.

Kumar V, Abbas A, Aster J. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Philadelphia: Elsevier; 2014.

Padmandani WPA, Dewi S, Hamijoyo L. Correlation between serum C-reactive protein (CRP) and soluble Cd40 ligand (sCD40L) with disease activity by modified rodnan skin score (mRSS) in systemic sclerosis patients in Indonesia. Ina J Rheum. 2018;10(2). [Cited 2021 January 28]. Available from:

Budiman AM, Dewi S, Prananta MS. Clinical manifestation and laboratory finding of sclerosis systemic patient in Dr. Hasan Sadikin General Hospital Bandung: a descriptive quantitative study. Ina J Rheum. 2018;10(1):15–9.

Hant FN, Herpel LB, Silver RM. Pulmonary manifestations of scleroderma and mixed connective tissue disease. Clin Chest Med. 2010;31(3):433–49.

Hassoun PM. Lung involvement in systemic sclerosis. Presse Med. 2011;40(1 Pt 2):e3–17.

Khanna D. Diagnosis and treatment of systemic and localized scleroderma. Expert Rev Dermatol. 2011;6(3):287–302.

Bussone G, Mouthon L. Interstitial lung disease in systemic sclerosis. Autoimmun Rev. 2011;10(5):248–55.

Solomon JJ, Olson AL, Fischer A, Bull T, Brown KK, Raghu G. Scleroderma lung disease. Eur Respir Rev. 2013;22(127): 6–19.

Wong CJ, Hamlin NP, editors. The perioperative medicine consult handbook. New York: Springer; 2013.

Agrawal N, Dave L, Shrivastava N, Sharma P. Study of clinico-radiological profile of interstitial lung disease patients attending CRGH Ujjain. Int J Med Sci Diagnosis Res. 2019;3(12):25–30.

Vizioli L, Ciccarese F, Forti P, Chiesa AM, Giovagnoli M, Mughetti M, et al. Integrated use of lung ultrasound and chest X-ray in the detection of interstitial lung disease. Respiration. 2017;93(1):15–22.

Varga J, Denton CP, Wigley FM, Allanore Y, Kuwana M, editors. Scleroderma: from pathogenesis to comprehensive management. 2nd ed. Cham, Switzerland: Springer International Publishing; 2017.

Assayag D, Kaduri S, Hudson M, Hirsch A, Baron M. High resolution computed tomography scoring systems for evaluating interstitial lung disease in systemic sclerosis patients. Rheumatology. 2012;(S1):003.

Meier FMP, Frommer KW, Dinser R, Walker UA, Czirjak L, Denton CP, et al. Update on the profile of the EUSTAR cohort: an analysis of the EULAR Scleroderma Trials and Research group database. Ann Rheum Dis. 2012;71(8):1355–60.

Suliman YA, Dobrota R, Huscher D, Nguyen-Kim TDL, Maurer B, Jordan S, et al. Pulmonary function tests: high rate of false-negative results in the early detection and screening of scleroderma-related interstitial lung disease. Arthritis Rheumatol. 2015;67(12):3256–61.

Morales-Cárdenas A, Pérez-Madrid C, Arias L, Ojeda P, Mahecha MP, Rojas-Villarraga A, et al. Pulmonary involvement in systemic sclerosis. Autoimmun Rev. 2016;15(11):1094–108.

Yani H, Dewi S, Rahmadi AR. Correlation between serum krebs von den lungen-6 levels with forced vital capacity and modified rodnan skin score of patients with restrictive lung disease in diffuse-type systemic sclerosis. Ina J Rheum. 2019;11(2):145–7.

Sambataro D, Sambataro G, Pignataro F, Maglione W, Malatino L, Vancheri C, et al. Quantification of ground glass opacities can be useful to describe disease activity in systemic sclerosis. Diagnostics (Basel). 2020;10(4):225.


Article Metrics

Abstract view : 319 times
PDF - 206 times

 This Journal indexed by




Creative Commons License
AMJ is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License


View My Stats