Pleural Involvement in Systemic Autoimmune Disorders

Abstract

Systemic autoimmune diseases, a heterogeneous group of immunologically mediated inflammatory disorders including multiorgan involvement, can affect the pleura with various frequencies, either as a single presenting feature or as part of multisystem involvement. Rheumatoid arthritis and systemic lupus erythematosus represent the most common immunological diseases that affect the pleural cavity; however, there is considerable variation regarding the reported prevalence, natural history and prognosis of pleural involvement in both conditions. The definition of pleural disease in the remaining systemic autoimmune disorders is unquestionably imprecise and assumptive, since it is risky to support premises based on single case reports or retrospective data from very small series. In this article, we will review the manifestations of pleural disease caused by rheumatoid arthritis, systemic lupus erythematosus, scleroderma, polymyositis/dermatomyositis, mixed connective tissue disease, ankylosing spondylitis, Sjögren’s syndrome and Wegener’s granulomatosis.

Thoracic Manifestations of Connective Tissue Diseases

“…Pleuritic pain is said to be present in 45%-60% of patients, and pleural effusions (unilateral or bilateral) have been reported in 30%-50% of patients with SLE. 28 Pericardial effusion and cardiomegaly may be present in up to 35% of patients (Fig 9). 27 Acute pulmonary disease in patients with SLE presenting patchy consolidation in HRCT images may represent pneumonia, acute lupus pneumonitis, alveolar hemorrhage, or pulmonary edema.…”

Romatoid artritte akciğer tutulumu

“…pH düzeylerinin 7.2'nin alt›na düfltü¤ü durumlarda ise efllik eden infeksiyon akla gelmelidir. [16] Yüksek LDL dü-zeyleri (700 IU/L üstü de¤erler) plevral inflamasyon derecesi göstergesi olarak kabul edilir ve tedavi cevab›n›n izleminde kullan›labilir. Romatoid artrite ba¤l› steril ampiyematöz plevral s›v›-n›n en önemli bulgular› plevral s›v› çok düflük glukoz dü-zeyi (40 mg/dl), plevral s›v› asidozu (pH<7.20), yüksek LDH düzeyleri (>700 IU/L), yüksek kolesterol düzeyleri (>65 mg/dL) ve bakteri kültürleri negatif bulunmas›d›r.…”

Pulmonary Manifestations of Systemic Lupus Erythematosus

“…(Good et al, 1983;Orens et al, 1994;Pines et al, 1985) Pleural effusion in SLE tends to be bilateral, small to moderate in size; however, large effusions may occur. (Bouros et al, 2008) Typical presentation of pleural involvement is pleuritic chest pain (pain that increases with inspiration), dyspnea, and fever. Physical examination may reveal pleural friction rub and signs of pleural effusion.…”