Pleurisy is a common complication in individuals with lupus and can significantly impact a patient's quality of life. This article provides insights into both pleurisy and lupus, exploring the relationship between them. It covers the symptoms, diagnosis, and treatment options for pleurisy in lupus patients, helping you understand these conditions more.

Pleurisy 

Pleurisy is a condition where the pleura becomes inflamed. The pleura is a serous membrane that folds back on itself to form a two-layered structure. The inner layer, known as the visceral pleura, envelops the lungs, while the outer layer, called the parietal pleura, lines the chest wall. These two layers are normally separated by the pleural cavity, which contains a small amount of fluid that helps them glide smoothly against each other.¹

When the pleura becomes inflamed, the inner and outer layers rub against each other during breathing, causing chest pain. This condition can result from a viral, bacterial, or fungal infection, as well as autoimmune disorders such as lupus or rheumatoid arthritis.²

Lupus

Lupus is a chronic condition that can cause inflammation and pain in different parts of the body systems. It is an autoimmune disease, meaning that the immune system, which typically fights infections, attacks healthy tissue instead. The exact cause of lupus is unknown, but it is believed to result from a combination of factors including genetic, ecological, and environmental influences.³

Types of lupus

• Systemic lupus erythematosus (SLE): You might see lupus referred to as SLE online as it is the most common form of lupus, affecting approximately 70% of individuals with the condition. SLE causes inflammation in multiple organs or organ systems in the body, either acutely or chronically
• Cutaneous lupus erythematosus: This form of lupus is limited to the skin
• Drug-induced lupus erythematosus: A lupus-like disease caused by certain prescription drugs
• Neonatal lupus: A rare condition affecting infants born to women with lupus⁴

Relationship between pleurisy and lupus

In SLE patients, the immune system mistakenly attacks healthy tissues, causing widespread inflammation. This autoimmune response can affect the pleura, leading to pleurisy. It is estimated that around 60% of lupus patients may experience some form of lung involvement during the course of their disease, with pleurisy being a frequent manifestation.⁵

Symptoms of pleurisy in lupus patients

In lupus, pleurisy can present with various symptoms, including:⁶

• Chest pain - This hallmark of pleurisy is caused by the pleural membranes rubbing against each other. It often worsens with breathing, laughing, coughing, or sneezing
• Dyspnea (shortness of breath) - The chest pain can make it difficult for individuals to take full breaths, leading to a sensation of breathlessness
• Cough - A dry, persistent cough that accompanies chest pain
• Fever - Inflammation of the pleura can be associated with fever

Diagnosis pleurisy in lupus patients

Diagnosing pleurisy in patients with lupus involves a combination of medical history review, physical examination, and diagnostic tests.These include:

• Patient history review - Detailed review of the patient's medical history, focusing on symptoms related to pleurisy such as chest pain, difficulty breathing, and a history of lupus flares
• Physical examination - During auscultation (listening to internal sounds of the body) of the lungs, a doctor listens for pleural rubs. Inflamed layers of the pleura can produce a rough, scratchy sound as they rub against each other, indicative of pleurisy⁷
• Imaging tests - Imaging tests, such as X-rays and CT (computerised tomography) scans, are used to detect pleural effusion (excess fluid in the pleural cavity) and signs of lung inflammation, which are common in pleurisy
• Blood test - blood test results showing elevated inflammation markers such as Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) indicate inflammation. Furthermore, Lupus-Specific Tests for antinuclear antibodies (ANA) and anti-double stranded DNA (anti-dsDNA) are specific to lupus and help in confirming the diagnosis⁸
• Pleural fluid analysis - If pleural effusion is present, analysis of fluid obtained through thoracentesis (needle decompression) can help in provide essential information regarding the cause of inflammation⁹

How do you treat pleurisy from lupus?

Management of pleurisy in lupus patients involves a range of treatment options tailored to the severity of the condition and the patient's overall health. These include:

• Anti-inflammatory drugs - Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce inflammation and pain in mild cases of pleurisy from lupus
• Immunosuppressants: Medications like corticosteroids suppress the immune system and are the drugs of choice for patients with severe pleurisy from lupus
• Lifestyle modification: Ensuring sufficient rest is crucial to support the body’s healing process. Maintaining a nutritious diet also helps support overall health and can aid in managing symptoms^7,8

FAQs

Can pleurisy be caused by lupus?

Yes, lupus can cause pleurisy. Lupus is an autoimmune disease where the immune system attacks its own tissues, including the pleura, leading to inflammation and pain in the chest area.

What does lupus chest pain feel like?

Lupus chest pain, often associated with pleurisy, feels sharp and stabbing, worsening with deep breathing, coughing, or sneezing.

What autoimmune disease causes pleurisy?

Lupus is a common autoimmune disease that can cause pleurisy. Other autoimmune diseases, such as rheumatoid arthritis, can also lead to pleurisy.

Can pleurisy in lupus patients be prevented?

While not always preventable, regular monitoring, medication adherence, and lifestyle modifications can help reduce the risk.

Summary

Pleurisy, pleura inflammation, is a common complication in individuals with lupus, an autoimmune disease. Lupus can cause widespread inflammation, including in the pleura, leading to symptoms such as chest pain, shortness of breath, and fever.

Diagnosis involves a combination of patient history, physical examination, imaging tests, blood tests, and pleural fluid analysis. Treatment options range from anti-inflammatory drugs to immunosuppressants and lifestyle modifications. Understanding the relationship between pleurisy and lupus is crucial for effective management and improving patients' quality of life.