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Thread: Lupus and Pleurisy/Pleuritis

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    Default Lupus and Pleurisy/Pleuritis

    The membrane sac that covers the lung becomes inflamed with fluid. The symptom is a severe stabbing pain when taking a deep breath.

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    From: THE LUPUS FOUNDATION OF AMERICA

    Pleurisy occurs when the double membrane (pleura) that lines the chest cavity and surrounds each of your lungs becomes inflamed. The condition, also called pleuritis, typically causes sharp pain, almost always during the act of breathing.

    One layer of the pleura, which is just a few cells thick, overlies each lung. The other layer lines the inner chest wall. When you breathe in, the large muscle separating the chest cavity from the abdominal cavity (diaphragm) contracts and your chest wall expands, causing your lungs to expand. The two layers of pleura are like two pieces of smooth satin rubbing against each other with almost no friction, allowing your lungs to expand and contract without any resistance from the lining of the chest wall.

    When inflamed, the two layers of the membrane in the affected side of your chest rub against each other, producing pain when you inhale and exhale. Between breaths, you feel almost no pain. At times, pleurisy causes an accumulation of fluid in the chest cavity (pleural effusion).

    Pleurisy occurs as a complication of a wide variety of underlying conditions. Relieving pleurisy involves treating the underlying condition, if it's known, and taking pain relievers.

    Signs and symptoms

    Inflammation of the membranes surrounding your lungs may cause the following signs and symptoms:

    * Shortness of breath
    * Chest pain during breathing
    * Dry cough
    * Fever and chills, depending on the cause

    The sharp, fleeting pain in your chest that pleurisy causes is made worse by coughing, sneezing, moving and deep breathing. You may find relief from pain when you hold your breath or when you apply pressure over the painful area.

    When an accumulation of fluids is associated with pleurisy, the pain usually disappears because the fluid serves as a lubricant. However, if enough fluid accumulates, it puts pressure on your lungs and interferes with their normal function, causing shortness of breath. If the fluid becomes infected, the signs and symptoms of dry cough, fever and chills may appear.

    Causes

    The underlying medical conditions that can cause pleurisy are numerous. They include:

    * An acute viral infection, such as the flu (influenza)
    * Pneumonia, in those cases in which the infected portion of the lung involves the pleural surface of the lung
    * Autoimmune conditions such as lupus, rheumatoid arthritis and autoimmune hepatitis
    * Tuberculosis and other infections
    * A clot in an artery of your lungs (pulmonary embolism)
    * Pancreatitis

    Screening and diagnosis

    Your doctor may make a diagnosis based on your signs and symptoms. Upon examining you and listening to your chest, your doctor may hear a "friction rub" that sometimes sounds like the crunching sound of walking on very dry snow.

    You may also undergo the following diagnostic procedures:

    * Imaging. A chest X-ray may show an area of inflammation in your lungs that indicates pneumonia. Your doctor will want to investigate an unexplained abnormality seen on an X-ray with additional imaging, usually beginning with a computerized tomography (CT) scan. In a CT procedure, a computer translates information from X-rays into images of thin sections (slices) of your chest. CT scans produce more detailed images of your internal organs than do conventional X-ray studies. Sometimes doctors want a special type of chest X-ray in which you lie on your side where the pleurisy is to see if there's any fluid that doesn't appear on a standard chest X-ray. This type of X-ray is called a decubitus chest X-ray.

    * Blood test. A blood test may tell your doctor whether your lungs are infected and what type of infection you have. Other blood tests may also detect an autoimmune disorder such as rheumatoid arthritis or lupus in which the initial sign is pleurisy.

    * Thoracentesis. To remove fluid for laboratory analysis, your doctor may suggest a procedure called thoracentesis. In this procedure, your doctor first injects a local anesthetic, then inserts a needle through your chest wall between your ribs to remove fluid. In addition, a sample of tissue (pleural biopsy) for microscopic analysis may be obtained if your doctor is concerned that the fluid collection may be caused by tuberculosis or cancer. If only a small amount of fluid is present, your doctor may insert the needle with the help of ultrasound over the site of the fluid.

    * Video-assisted thoracic surgery (VATS). Another way of obtaining a sample of pleural tissue is by a surgical procedure called video-assisted thoracic surgery. In VATS, a tube is inserted to collapse a lung to about one-quarter its normal size. This creates a space through which your doctor can insert a pen-sized instrument through your chest wall to take a tissue sample under video guidance.

    # Chest X-rays: Helping detect heart and lung conditions

    # Computerized tomography

    Treatment

    The most important goal in relieving pleurisy or pleural effusions is treatment of the underlying condition that's causing your signs and symptoms. For example, if the cause of pleurisy is a bacterial infection of your lung (pneumonia), an antibiotic may control the infection. But, for pleurisy due to a viral infection, antibiotics won't be effective. The outcome of treatment may depend on the seriousness of the underlying disease.

    Over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDs) may help relieve some of the signs and symptoms of pleurisy. Prescription codeine may help control a cough as well as the pain. If you have a large buildup of fluid, you may need to stay in the hospital to have the fluid drained over a period of several days through a tube inserted into your chest.

    Most cases of pleuritis of unknown cause heal with time.

    # Nonsteroidal anti-inflammatory drugs (NSAIDs) [/b]

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