Systemic Lupus Erythematosus (Lupus) is a chronic autoimmune disease where the body’s immune system mistakenly attacks its own healthy tissues and organs. This condition causes widespread inflammation affecting many body systems, including the joints, skin, kidneys, heart, and lungs. Pleurisy, or pleuritis, is the inflammation of the pleura—the thin membranes lining the lungs and the inside of the chest cavity. This inflammation is a recognized complication of Lupus, often referred to specifically as lupus pleuritis.
Lupus as a Cause of Pleurisy
Lupus pleuritis arises directly from the systemic nature of the autoimmune disorder, where the immune system targets the pleura. The pleura consists of two layers—the visceral pleura covering the lungs and the parietal pleura lining the chest wall—which typically glide smoothly past one another during breathing. In Lupus, the overactive immune response generates autoantibodies that attack the pleural tissue, causing inflammation. This inflammation makes the normally slick pleural surfaces rough and irritated.
The roughened layers of the pleura rub against each other with every breath, leading to characteristic pain. This autoimmune attack can also lead to the accumulation of excess fluid between the layers, a condition known as pleural effusion. Pleural involvement is considered the most common type of lung disease associated with Lupus.
Estimates suggest that 40% to 60% of individuals with Lupus will experience pleuritis at some point. This complication frequently occurs during a Lupus flare, when underlying disease activity is heightened. Pleurisy is one of the clinical criteria used by physicians to diagnose Lupus, underscoring the strong link between the two conditions.
Recognizing the Specific Symptoms
The primary symptom of pleurisy is a sharp, stabbing, or aching chest pain. This pain is characteristically described as pleuritic, meaning it intensifies significantly with deep breathing, coughing, sneezing, or laughing. The discomfort is caused by the inflamed pleural layers rubbing together as the lungs expand and contract. It is often localized to one side of the chest, though it can sometimes radiate to the shoulder or back.
Patients may also experience shortness of breath (dyspnea) because the chest pain discourages taking a full breath. A dry or persistent cough can accompany the chest pain, particularly if there is a significant accumulation of fluid. Since pleurisy is often a sign of an active Lupus flare, patients may also notice general symptoms like fever and increased fatigue.
Diagnosis and Management Approaches
Confirming a diagnosis of lupus-related pleurisy involves clinical evaluation, imaging, and laboratory work. A physician will first assess the patient’s symptoms and listen to the chest for a pleural friction rub, a grating sound that signals inflamed pleural layers. Imaging tests visualize the lungs and the pleural space, often starting with a chest X-ray to check for a pleural effusion.
More detailed imaging, such as a computed tomography (CT) scan or ultrasound, may be used to define the extent of fluid accumulation. Laboratory tests, including blood work, help gauge the overall activity of Lupus and rule out other causes like infection. If a substantial pleural effusion is present, a procedure called thoracentesis may be performed to draw off a sample of the fluid for analysis. This analysis confirms the inflammatory nature of the fluid, which is typical in Lupus pleuritis.
Management of lupus pleuritis focuses on both reducing inflammation and controlling the underlying autoimmune disease. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen are the first line of treatment to manage pain and mild inflammation. For more severe cases, or when NSAIDs are not sufficient, corticosteroids like prednisone may be prescribed to quickly suppress the autoimmune inflammation. If the pleurisy is recurrent or severe, other immunosuppressive medications may be introduced to control the Lupus activity long-term.