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Clinical perspective and practices on pleural effusions in chronic systemic inflammatory diseases
Xuan Yao1,2,3, Megat Abd Hamid1,2,3, Anand Sundaralingam4
1Chinese Academy of Medical Sciences Oxford Institute, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.
Breathe (Sheffield, England)
|January 15, 2021
Summary
Connective tissue disease (CTD) can cause pleuritis, leading to pleural effusions and chest pain. While common in rheumatoid arthritis and lupus, pleural involvement is rare in other CTDs.
Area of Science:
- Rheumatology
- Pulmonology
- Immunology
Background:
- Systemic inflammatory diseases encompass autoimmune disorders affecting multiple body systems.
- Connective tissue diseases (CTDs) are a major category characterized by immune-mediated connective tissue inflammation.
- Pleural manifestations are common complications of CTDs, presenting with diverse symptoms like exudative pleural effusions and chest pain.
Purpose of the Study:
- To review the pathophysiological mechanisms of CTD-induced pleuritis.
- To discuss clinical considerations for managing CTD-related pleural involvement.
- To highlight the variable prevalence of pleural pathology across different CTDs.
Main Methods:
- Literature review of CTD-induced pleuritis.
- Analysis of prevalence data for pleural involvement in various CTDs.
- Discussion of clinical presentation and management strategies.
Main Results:
- CTD-induced pleuritis presents with varied symptoms, including exudative pleural effusions and chest pain.
- Prevalence of pleural pathology differs significantly among CTDs: 5-20% in rheumatoid arthritis and 17-60% in systemic lupus erythematosus.
- Pleural involvement is rare in systemic sclerosis, eosinophilia-myalgia syndrome, mixed connective tissue disease, ankylosing spondylitis, polymyositis, and dermatomyositis.
Conclusions:
- CTD-induced pleuritis is a significant manifestation, though challenging to accurately estimate prevalence due to asymptomatic cases.
- Clinical management is guided by symptom severity, with most effusions resolving spontaneously.
- Understanding the specific CTD is crucial for assessing the risk and potential outcomes of pleural involvement.
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