Clinical perspective and practices on pleural effusions in chronic systemic inflammatory diseases

Abstract

Systemic inflammatory diseases are a heterogeneous family of autoimmune chronic inflammatory disorders that affect multiple systems within the human body. Connective tissue disease (CTD) is a large group within this family characterised by immune-mediated inflammation of the connective tissue. This group of disorders are often associated with pleural manifestations. CTD-induced pleuritis exhibits a wide variety of symptoms and signs including exudative pleural effusions and chest pain. Accurate estimation of prevalence for CTD-related pleuritis is challenging as small effusions are asymptomatic and remain undetected. Rheumatoid arthritis and systemic lupus erythematosus are frequent CTDs and present with pleural pathology in approximately 5–20% and 17–60% of cases, respectively. By contrast, pleural involvement in systemic sclerosis, eosinophilia–myalgia syndrome, mixed connective tissue disease, ankylosing spondylitis, polymyositis and dermatomyositis syndrome is rare. Clinical management depends on the severity of symptoms; however, most effusions resolve spontaneously. In this review we discuss the pathophysiological mechanisms and the clinical considerations of CTD-induced pleuritis.

Idiopathic recurrent serositis—Off the beaten track

“…Connective tissue diseases such as rheumatoid arthritis and systemic lupus erythematosus can present with pleural pathology in approximately 5%–20% and 17%–60% of cases, respectively, 7 and most effusions resolve spontaneously. Corticosteroids may be administered in cases of persistent effusion to aid resolution.…”

Inflammation of the Pleural Cavity: A Review on Pathogenesis, Diagnosis and Implications in Tumor Pathophysiology

“…Connective tissue diseases can be associated with pleural involvement, which varies from the formation of pleural effusion to simply pleural inflammation/thickening, thus presenting with various manifestations ranging from dyspnea to pleuritic chest pain and fever [32]. Incidence of pleural effusion is reported in 5-20% of rheumatoid arthritis patients, 17-60% of systemic lupus erythematosus patients (SLE), in 5-55% of granulomatosis with polyangiitis patients and in 7% of systemic sclerosis (scleroderma) patients [32].…”

Pleuraerguss bei Patienten mit Psoriasis-Arthritis: An Nebenwirkungen von TNF-α-Blockern denken

“…Während ein Pleuraerguss bei Morbus Behçet, Dermatomyositis, Sjögren-Syndrom, Mischkollagenose (mixed connective tissue disease, MCTD) oder der Psoriasis-Arthritis (PsA) selten auftritt, ist der Pleuraerguss eine charakteristische respiratorische Manifestation beim systemischen Lupus erythematodes. Bei anderen Systemerkrankungen wie der rheumatoiden Arthritis, dem Churg-Strauß-Syndrom, der eosinophilen Granulomatose mit Polyangiitis oder der Sklerodermie wird ein Pleuraerguss mit einer intermediären Häufigkeit beschrieben [1-3]. Typischerweise handelt sich bei den Pleuraergüssen bei rhSE um Exsudate [3].…”