Pulmonary complications in lupus: causes, symptoms and treatment

Lupus is one of many types of autoimmune diseases, which are usually characterized by chronic joint pain and skin disorders that are difficult to treat. But in fact, lupus can not only affect joints and skin. The function of various organs in the body can also be disrupted as a complication of lupus, for example the lung organs.

Why can this condition occur, and can lupus and pulmonary treatment be done together? I will explore all the information regarding pulmonary complications in lupus sufferers through the following review.

Why can lupus cause complications in the lungs?

Lupus is a disease that can attack many organs (multi organs). Starting from the brain, kidneys, heart, blood, skin, to the lungs. Yes, the lungs are indeed one of the organs that can be attacked by lupus.

Usually, lung disease is caused by bacterial, fungal, and viral infections. However, when a person has lupus, the disease can cause abnormalities or complications in the lungs.

In other words, a problem with the lung organs is actually a symptom of lupus. The cause of pulmonary complications in lupus patients can be caused by the autoimmune reaction itself.

Autoimmune is a condition in which the immune system, aka the immune system, is not functioning properly. In fact, the immune system is supposed to play a role in fighting viral, bacterial, fungal and other foreign body infections.

As a result, the immune system attacks healthy organs and parts of the body, causing disease, including lung problems. All parts of the lung can be affected by complications from lupus.

Starting from the lining of the lung (pleura), lung tissue (lung parenchyma), and air sacs in the lungs (alveoli). Not just one, but there are several pulmonary complications that can occur in lupus patients, such as:

• Interstitial lung disease (interstitial lung disease). It usually affects about 3-10 percent of lupus patients.
• Inflammation of the lining of the lung (pleurisy). It usually affects 34-78 percent of lupus patients.
• Lupus pneumonitis. It usually affects about 1-4 percent of lupus patients.
• Diffuse alverolar hemorrhage (DAH). It usually affects about 0.5-5.7 percent of lupus patients.
• Pulmonary embolism. It usually affects about 5-10 percent of lupus patients.
• Pulmonary hypertension. It usually affects about 9.3-14 percent of lupus patients.

Each pulmonary complication in lupus patients generally has different symptoms and treatment.

What are the symptoms and diagnosis of lung disease in people with lupus?

In general, there are a variety of symptoms that you shouldn't ignore if you have lupus. For example, chest pain when inhaling, dry cough, coughing up blood, shortness of breath, wheezing, and chest pain for a long time.

To be clearer, here I describe one by one the symptoms of lung disease which is a complication in lupus patients:

Interstitial lung disease (interstitial lung disease)

Interstitial lung disease generally causes lupus patients to cough for a long time. Symptoms of interstitial lung disease as a complication in lupus patients are usually relatively mild, so they are often ignored.

You may just have a dry cough that goes away and comes on intermittently, accompanied by mild shortness of breath. Doctors can diagnose this disease with a CT scan of the lungs.

As the disease progresses, the interstitial lung can cause stones to get worse. In fact, you will also experience chest pain and shortness of breath, which can even interfere with daily activities.

Pleuritis

Other pulmonary complications in lupus patients can cause pleurisy. Pleuritis can occur due to inflammation of the thin membrane covering the lungs (pleura).

The main complaint that is usually experienced by lupus patients with pleurisy disease includes the appearance of pain in the chest, especially when breathing in. In some more severe cases, you may experience difficulty breathing or shortness of breath.

Lupus patients with this one lung disease can also complain of a long cough and fever. To diagnose it, the doctor will perform an x-ray or x-ray, to see if there is fluid in the chest cavity.

Lupus pneumonitis

Lupus pneumonitis can resemble pneumonia, but it is not caused by infection in lupus patients. Lupus pneumonitis can cause you to experience coughing, shortness of breath, coughing up blood, and even chills.

As a form of examination related to pulmonary complications in this lupus patient, the doctor will perform an X-ray or x-ray. The goal is to look for spots on both lungs.

The appearance of these spots is often difficult to distinguish from ordinary pneumonia. Lupus pneumonitis must be treated immediately, because it can be fatal if it is too late.

Diffuse alveolar hemorrhage

Diffuse alveolar hemorrhage (DAH) is a very rare, but dangerous, pulmonary complication in lupus patients. The reason is, DHA can be fatal if not treated immediately.

That is why, this condition is often referred to as rheumatologic emergency , aka emergency conditions in the field of rheumatology. This condition can be characterized by bleeding in the air sacs (alveoli) in the lungs.

Patients usually experience a bloody cough, which is accompanied by severe shortness of breath. The way to diagnose DAH is with a chest X-ray to find spots on the lungs, and followed by bronchoscopy to see bleeding.

Pulmonary embolism

Pulmonary embolism can occur because a blood clot flows through the blood vessels and settles in the pulmonary veins. Lupus patients have a 20 times higher risk of developing pulmonary embolism than people without lupus.

This is also because about 20-30 percent of lupus patients have anti-phospholipid antibodies that can increase the risk of pulmonary embolism. Pulmonary embolism is an emergency situation that requires immediate treatment.

This disease is characterized by sudden shortness of breath and severe chest pain. Tests to diagnose pulmonary embolism include spiral CT pulmonary angiogram, or V / Q scan and pulmonary angiography.

Pulmonary hypertension

Pulmonary hypertension is a pulmonary complication in lupus patients, which is caused by increased pressure on the blood vessels.

There are about 10-15 percent of lupus patients who experience mild pulmonary hypertension, even without symptoms. If present, the initial symptoms of this disease are usually mild shortness of breath which is sometimes accompanied by chest pain, weakness and temporary loss of consciousness (syncope).

How is lupus treated which causes complications in the lungs?

In fact, the doctor will usually find out in advance whether your lung disease is caused by an infection or a form of complications from lupus.

Lung disease caused by infection is usually not certain that you have lupus, and it may not even be experienced by lupus patients. In this case, treatment will usually lead directly to the lung disease that you are experiencing.

Meanwhile, if lung disease occurs due to complications in lupus patients, of course the treatment will be adjusted according to lupus. You see, in lupus patients, before experiencing lung disease, lupus disease already exists.

So, it is lupus that then causes problems and various symptoms in the lung organs. Therefore, the main treatment that doctors will give is treatment for lupus.

As lupus improves, lung disease will usually get better as well. The following are drug options to treat pulmonary complications in lupus patients according to their conditions:

Interstitial lung disease (interstitial lung disease)

Doctors can provide early stage treatment in the form of steroids and immunosuppressant drugs. For example, such as azathioprine, mycophenolate mofetil, or cyclophosphamide.

If the diagnosis is late and the lung tissue has formed extensive scar tissue, treatment may be quite difficult. As a result, usually a lung transplant is required.

Pleuritis

Pleurisy treatment depends on the severity of the patient's condition. If classified as mild, treatment can be given with low doses of corticosteroids, such as prednisone, methylprednisolone etc.

Other options can also be given immunosuppressants such as azathioprine, mycophenolate mofetil, and cyclophosphamide. In certain conditions, doctors may recommend surgery.

Lupus pneumonitis

Pulmonary complications in lupus patients in the form of lupus pneumonitis can be treated with high doses of corticosteroid therapy.

Other immunosuppressants can also be given, for example azathioprine, mycophenolate mofetil, or cyclophosphamide. Sometimes, intravenous immunoglobulin (IVIG) may also be used.

Diffuse alveolar hemorrhage

Treatment of DAH usually includes administering high doses of injectable steroids, or other immunosuppressant drugs depending on your condition. Take for example the drugs cyclophosphamide, rituximab or mycophenolate mofetil.

In certain conditions, intravenous immunoglobulin (IVIG) or plasmapheresis can also be given. If you have anemia, occasionally a blood transfusion may be necessary.

Pulmonary embolism

Pulmonary embolism due to pulmonary complications in lupus patients is usually treated with heparin injection, accompanied by oral anticoagulants, for example warfarin.

Pulmonary hypertension

Lupus patients are expected to screen for pulmonary hypertension. For example, by checking transthoracic echocardiogram (TTE), or right heart catheterization.

It is important to always consult a doctor regarding any complaints you experience. Because maybe, this is a complaint related to pulmonary complications in lupus.

The sooner the diagnosis is made, the sooner treatment will be given. That way, your condition can be handled more quickly in order to prevent the possibility of bad things happening in the future.

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