While lupus can affect the lungs in many ways, pleuritis (pleurisy) is the most common pulmonary manifestation.
The pleura is a membrane that covers the outside of the lung and the inside of the chest cavity. It produces a small amount of fluid to lubricate the space between the lung and the chest wall. As lupus activity generates immune complexes, they initiate an inflammatory response at this membrane, a condition called pleuritis.
Symptoms of pleuritis
- severe, often sharp, stabbing pain that may be pinpointed to a specific area or areas of the chest.
- sometimes the pain is made worse by taking a deep breath, coughing, sneezing, or laughing.
Sometimes an excessive amount of fluid builds up in the pleural space between the lung and the chest wall. This is called a pleural effusion and occurs less often then pleuritis.
Diagnosing pleural effusion
If the effusion is large enough, it can be seen on a chest x-ray. Since infection or conditions other than lupus can cause pleural effusions, the physician may need to take a sample of the fluid and perform tests to help determine its cause.
Treating pleural effusion
Pleural effusions will usually respond to these medications:
- non-steroidal anti-inflammatory drugs (NSAIDs)
Pleural effusions also may clear by themselves with time.
Pneumonitis is inflammation within the lung tissue. Infection is the most common cause of pneumonitis in people with lupus. Bacteria, virus, or fungi are organisms that can cause infection in the lung. Sometimes pneumonitis may occur without infection and is then called non-infectious pneumonitis.
Symptoms of pneumonitis
- chest pain
- shortness of breath
Since both forms of pneumonitis have the same symptoms, the patient is assumed to have an infection until proven otherwise. The diagnosis of pneumonitis requires:
- blood tests
- sputum (mucus coughed up from the lungs) tests