TY - JOUR T1 - Dr. Henderson, <em>et al</em> reply JF - The Journal of Rheumatology JO - J Rheumatol SP - 1926 LP - 1926 DO - 10.3899/jrheum.130897 VL - 40 IS - 11 AU - LAUREN A. HENDERSON AU - STEPHEN H. LORING AU - PAUL F. DELLARIPA AU - PETER A. NIGROVIC Y1 - 2013/11/01 UR - http://www.jrheum.org/content/40/11/1926.2.abstract N2 - To the Editor:We are grateful for the thoughtful commentary of Dr. Eberlein1 on our recent study of shrinking lung syndrome (SLS)2.We reported that SLS was associated with 2 abnormalities of pulmonary physiology: (1) reduced inspiratory force at high but not low lung volumes, a pattern noted in pleuritis; and (2) markedly reduced lung compliance, in the absence of interstitial lung disease as determined by chest tomography and gas diffusion. Recognizing that SLS is frequently associated with episodes of chest pain and/or small pleural effusions, and presents clinically as gradually progressive dyspnea that stops short of respiratory failure, we proposed a new working model for SLS. Briefly, we hypothesized that SLS begins with pleuritis that triggers voluntary and reflex splinting of the chest wall. Chronic hypoinflation leads to gradual but persistent impairment of compliance, a process recognized in patients with high spinal cord injuries and in other … Address correspondence to Dr. P.A. Nigrovic, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Smith Building Room 516b, One Jimmy Fund Way, Boston, MA 02115, USA. E-mail: pnigrovic{at}partners.org ER -