From the Guidelines
A female with chest and back pain with respiration who has lupus should be evaluated urgently for pleuritis, which is inflammation of the lung lining and a common pulmonary complication of systemic lupus erythematosus (SLE). The patient's symptoms, such as chest and back pain with respiration, are consistent with pleuritis, which is a common pulmonary complication of SLE, affecting up to 90% of patients with SLE throughout the course of their disease 1.
Potential Pulmonary Complications
Other potential lupus-related pulmonary complications that should be ruled out include:
- Pneumonitis
- Pulmonary hypertension
- Shrinking lung syndrome
- Pulmonary embolism These complications require different management approaches and can significantly impact quality of life and mortality if not properly managed.
Diagnostic Approach
The patient should undergo:
- Chest X-ray
- Pulmonary function tests (PFTs), including spirometry and DLCO
- Possibly CT imaging to determine the specific complication Pleuritic pain in lupus results from immune complex deposition and inflammation in the pleural lining, causing sharp pain that worsens with deep breathing or coughing 2.
Treatment Approach
Initial treatment typically includes:
- NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for mild cases
- For moderate to severe symptoms, prednisone (20-40mg daily, tapered over several weeks) may be necessary If the patient is already on immunosuppressive therapy for lupus, their regimen may need adjustment 3. Prompt medical attention is essential as respiratory complications can significantly impact quality of life and may become life-threatening if not properly managed. Routine clinical assessment of patients with SLE should include careful evaluation of respiratory involvement, and symptoms such as dyspnea, chest pain, reduced exercise tolerance, cough, and hemoptysis should prompt a search for an underlying lung disease 3.
From the Research
Potential Pulmonary Complications of SLE
The potential pulmonary complications of Systemic Lupus Erythematosus (SLE) in a female patient experiencing chest and back pain with respiration include:
- Pleuritic chest pain 4, 5
- Diffuse interstitial lung disease 4, 5, 6
- Acute lupus pneumonitis 4, 6
- Pulmonary arterial hypertension (PAH) 5
- Pulmonary embolic disease 5
- Pulmonary vasculitis 5
- Shrinking lung syndrome 5, 7
- Pleurisy and pleural effusion 4, 5
Clinical Presentation and Diagnosis
These conditions can present with a combination of dyspnea, cough, and chest pain, but some patients may be asymptomatic, with the only suggestion of the respiratory disorder being found incidentally on thoracic imaging or pulmonary function tests 5. High-resolution computed tomographic scans of the chest and pulmonary function tests can help establish a diagnosis and aid long-term follow-up of these patients 6.
Treatment Options
Treatment decisions are often based on evidence from case reports or small case series, given the paucity of clinical trial data specifically focused on pulmonary manifestations of SLE 5. Therapeutic options may include:
- Non-steroidal-anti-inflammatory drugs for pleuritic pain 4
- High-dose corticosteroids for more severe cases of pleurisy with effusion, lupus pneumonitis, and diffuse interstitial lung disease 4, 6
- Immunosuppressive drugs such as azathioprine and cyclophosphamide for lupus pneumonitis or interstitial lung disease unresponsive to steroids 4, 6
- Rituximab for shrinking lung syndrome 7
- Combined therapy with corticosteroids, immunosuppressives, and plasmapheresis for fulminant cases of diffuse pulmonary hemorrhage attributed to lupus 4