Pericardial and Pleural Complications in Systemic Sclerosis

Abstract

Involvement of the pericardium in systemic sclerosis (SSc) is common, but rarely clinically apparent. Pericardial involvement consists of fibrinous pericarditis, pericardial adhesions, and acute or chronic pericarditis with or without effusion. Most pericardial effusions are small and asymptomatic, and are typically exudative; tamponade is rare. Patients typically present with dyspnea, chest pain, and fever.

Pleural disease in SSc is less common than parenchymal lung disease. Pleural effusions are uncommon, typically exudative, and are more likely to be found in patients with diffuse disease. Large or symptomatic pleural effusions due to SSc alone have not been described.

The principles of treatment for SSc-associated pleural and pericardial effusions include corticosteroids, ASA, NSAIDs, and colchicine, with evidence for methotrexate in chronic effusions.