At some time during their course, most patients with systemic lupus erythematosus (SLE) show signs of involvement of the lung, its vasculature, the pleura, and/or the diaphragm [1-5]. Pleurisy, coughing, and/or dyspnea are often the first clues either to lung involvement or to SLE itself . In some cases, however, abnormal pulmonary function tests (PFTs), including the diffusing capacity for carbon monoxide (DLCO) and/or abnormal chest radiographs, may be detected in asymptomatic patients . Pulmonary abnormalities do not correlate with complement levels, antinuclear antibody (ANA) levels, or other specific autoantibody levels such as anti-double-stranded DNA (dsDNA) and anti-Sm .
Patients with SLE and lung involvement must always be evaluated for infection, particularly that due to bacteria or viruses. Given that many are immunocompromised, tuberculosis, fungal infections, and other opportunistic infections should also be considered [9,10].
Overviews of the clinical manifestations of SLE in adults and children and a review of pulmonary disease in children with lupus are presented separately. (See "Overview of the clinical manifestations of systemic lupus erythematosus in adults" and "Systemic lupus erythematosus (SLE) in children: Clinical manifestations and diagnosis", section on 'Pulmonary disease'.)
PLEURITIC CHEST PAIN
Chest pain on breathing occurs in approximately 50 percent of patients with SLE [11,12]. It may be due to musculoskeletal causes or to pleuritis.
Musculoskeletal pain — In our experience, the most common cause of chest pain in systemic lupus erythematosus (SLE) is from muscles, connective tissues, or the costochondral joints (costochondritis or Tietze’s syndrome). The chest pain is characterized by painful deep breaths, aggravated by motion or by change of position (especially during sleep), and elicited by palpation of the painful areas. The patient can be reassured that this specific pain does not represent lung involvement. (See "Major causes of musculoskeletal chest pain in adults".)