Systemic lupus erythematosus pleurisy

Procainamide may induce a syndrome similar to systemic lupus erythematosus. This syndrome consists of arthralgias, myalgias, pleurisy, rash, fever, and elevated nuclear antibodies. Patients who are slow acetylators are at increased risk for developing this syndrome. While some studies have reported that less than one in 500 on chronic procainamide therapy developed this syndrome, others have reported this syndrome in up to 30% of patients on long-term therapy. Other side effects with chronic use include development of neutropenia, thrombocytopenia, hemolytic anemia, agranulocytosis, liver failure, a myasthenia-like syndrome, and psychosis with hallucinations. 

Indications 1) Suspended rheum and 2) replete water. Tuberculous exudative pleurisy, rheumatic pleurisy, ascites due to cirrhosis, schistosomiasis, nephritis, or uremia from systemic lupus erythematosus. 

Chalmers [111] reported 6 rheumatoid arthritis patients with D-penidllamine-induced systemic lupus erythematosus syndrome. All patients had previous mucocutaneous reactions to chry so therapy. Manifestations included pleurisy in 5 of 6 patients, rashes in 3, and nephritis in 2. LE cells were present in 5 patients. 

Systemic lupus erythematosus (SLE) is a systemic auto-immune disease of unknown cause in which tissues and cells are damaged by pathogenic autoantibodies and immune complexes. Ninety per cent of cases are in women, usually of childbearing age. Pleurisy and pleural effusions are common manifestations of SLE. Interstitial pneumonitis leading to fibrosis occurs occasionally. Pulmonary hypertension is a serious, uncommon manifestation of SLE. Many autoantibodies could be detected in SLE patients the most frequent are antinuclear antibodies (Keren) (90% of patients) the most specific antibodies are anti-DNA (70% of patients) and anti-Sm (30% of patients). 

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