Lupus Chest Pain: Causes, Symptoms, and Preventing Flare-Ups

Understanding Lupus Chest Pain

Lupus is an autoimmune disease that can cause inflammation and pain in any part of the body. Chest pain is one of the most common lupus symptoms, reported in up to half of patients. Lupus-related chest pain can stem from inflammation of the ribs and sternum, lung involvement, or heart complications.

Recognizing the characteristic features of lupus chest pain allows for proper diagnosis and treatment. Understanding the possible causes and risk factors helps patients identify warning signs and achieve relief through ongoing disease management.

What Causes Chest Pain in Lupus?

There are several ways lupus can trigger chest discomfort:

• Pleuropericarditis - Inflammation of the pleura (lung lining) and pericardium (heart covering) causing sharp chest pain, especially with breathing.
• Pericarditis - Inflammation of just the pericardium also causing painful breathing.
• Pleuritis - Inflammation isolated to the pleura, worsened by deep breaths.
• Myositis - Inflammation of the muscles between the ribs leading to chest tenderness.
• Endocarditis - Rare heart valve inflammation that feels like pressure or squeezing pain.

Other less common culprits can include pneumonia, blood clots in the lung, or lupus-associated coronary artery disease. Rarely, chest pain may signal impending heart attack or aortic dissection.

Characteristics of Lupus Chest Pain

Lupus chest pain has some unique features that help distinguish it from pain stemming from heart conditions:

• Sharp, stabbing, or burning pain rather than dull, pressure, or squeezing
• Pain worsens with deep breathing or coughing
• Mild to moderate severity, not extremely intense
• Lasts for weeks if untreated rather than minutes to hours
• No radiation to left arm, jaw, or back typically
• Occurs in young to middle-aged patients, more often female

Affected areas feel very tender to touch. Some patients describe pain when swallowing. Low grade fever and fatigue often accompany lupus chest discomfort.

Risk Factors for Lupus Chest Pain

Certain factors raise risk of developing lupus chest pain:

• Existing diagnosis of lupus, especially systemic lupus erythematosus (SLE)
• History of pleuritis, pericarditis, or myositis flares
• Recent viral illness like flu or COVID-19
• Medication nonadherence
• High lupus disease activity and inflammation
• Failure to avoid sunlight and UV exposure
• Emotional or physical stress
• Hormonal factors during pregnancy or menstruation

Lupus patients should monitor for chest pain symptoms, especially when these risk factors are present. Prompt treatment can prevent complications.

Diagnosing Lupus Chest Pain

If you have lupus and experience new onset chest pain, call your rheumatologist promptly. Characterizing the pain pattern and timing your doctor will determine if a lupus flare is likely.

Diagnostic tests confirm the source of pain and rule out life-threatening conditions like blood clots, pneumonia, or heart attack:

• Physical exam - Check for lung, heart, and chest wall tenderness.
• Blood tests - Evaluate inflammatory markers, cells, and lupus antibodies.
• Chest x-ray - Identify lung inflammation or fluid characteristic of pleuritis/pleuropericarditis.
• CT scan - Provides detailed lung images to assess for blood clots or pneumonia.
• EKG - Records the heart's electrical activity to rule out heart attack or pericarditis.
• Echocardiogram - Uses ultrasound to check for heart valve damage or fluid around the heart.

These tests determine the presence of lupus-related inflammation versus other concerning causes of chest discomfort requiring emergency treatment.

Treating Lupus Chest Pain

Treatment focuses on reducing inflammation and managing lupus disease activity. Typical approaches include:

• NSAIDs - Non-steroidal anti-inflammatory drugs like ibuprofen to alleviate pain and swelling.
• Steroids - Oral corticosteroids like prednisone to dampen the overactive immune response.
• Immunosuppressants - Medications like methotrexate, azathioprine, or mycophenolate mofetil for longer term prevention.
• Biologics - Targeted antibodies such as Benlysta (belimumab) to reduce lupus antibody activity.
• Plaquenil - Hydroxychloroquine to help control overall lupus disease activity long term.
• Rest - Avoiding strenuous activity allows the inflammation to subside.

Treating the underlying lupus helps resolve acute chest discomfort while preventing recurrent episodes. Lifestyle measures like stress reduction, healthy diet, and rest support the treatment plan.

Preventing Lupus Chest Pain Flare-Ups

Ongoing lupus management and vigilance for warning signs are key to reducing chest pain flares:

1. Take Medications as Directed

Staying adherent to your lupus and immunosuppressive medications keeps your immune system in check and disease activity controlled. Never stop treatment without medical guidance.

2. Avoid Infections

Infections like bronchitis, COVID-19, and pneumonia increase inflammation and lupus flares. Wash hands frequently, get recommended vaccines, and contact your doctor at the first sign of illness.

3. Monitor Disease Activity

Routine doctor visits allow monitoring for rising lupus antibody levels and emerging symptoms indicating a flare. Early detection helps initiate treatment promptly.

4. Reduce Stress

High stress exacerbates lupus activity. Make time for relaxing activities like yoga, meditation, massages, reading, and nature walks. Maintain good sleep habits and healthy relationships.

5. Limit Sun Exposure

Sunlight and UV rays can trigger lupus flares. Apply SPF 30 sunscreen when outdoors and wear protective clothing, hats, and sunglasses.

6. Eat an Anti-Inflammatory Diet

An anti-inflammatory diet high in fruits, vegetables, fish, and whole grains may help reduce lupus disease activity. Avoid processed foods and limit alcohol, salt, and saturated fat.

7. Don't Smoke

Smoking increases inflammation and risk of lupus complications like pleurisy. Quit smoking and avoid secondhand smoke to protect your health.

8. Exercise Regularly

Low impact activities like walking, swimming, and yoga help manage pain, improve stamina, and reduce flare-ups without worsening joint and chest discomfort.

Being attuned to your body and adhering to your doctor's recommendations offers the best protection against recurrent pain episodes.

When to Seek Emergency Care for Chest Pain

In rare cases, lupus chest pain may indicate a medical emergency requiring immediate evaluation, such as:

• Sudden, crushing chest pain radiating to the arm, neck, or jaw, which could signal heart attack
• Shortness of breath or difficulty breathing
• Coughing up blood
• Dizziness, rapid heart rate, profuse sweating
• Uncontrolled hypertension

If you have any concern your chest pain could be stemming from a life-threatening heart or lung condition, call 911 or go to the nearest ER. Better to err on the side of caution when it comes to chest pain.

Living with Lupus Chest Discomfort

Experiencing repeated bouts of pleuritis, pericarditis, or chest muscle pain related to lupus can negatively impact quality of life. However, with proper preventive strategies, you can reduce frequency and severity of flares.

Monitoring for early signs of chest pain allows prompt medical attention to avoid progression to debilitating pain. Your rheumatologist will tailor treatment to address recurrent episodes.

Let your doctor know if lupus chest pain is not adequately controlled with your current treatment regimen. Finding the right medications and lifestyle adjustments provides the best chance of remission.

Open communication with your healthcare team along with diligent self-care allows you to live well with lupus and minimize troublesome chest discomfort.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.