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What Causes Pleuritis?

Posted on Wed, 29 Apr 2015

Question: I have been experiencing ongoing pain in the right side of my rib cage for several days now. It hurts to cough and is worse when lying down. Have a history of rheumatoid arthritis Serro negative type and Costochronditis but this has always presented in the sternum area usually on the left side. Could this current pain be costochronditis too or pleurisy or Tietzes syndrome? The ribs on my right side are swollen when I stand side on and look in the mirror? I do gain some relief from a hot water bottle, some voltaren emulgel and Panadol but it is short lived. Can't take anti inflammatories because of a history of stomach ulcers and severe gastritis when taking them.

Answered by Dr. Michelle Gibson James (47 minutes later)

Brief Answer:
pleuritis/pleurisy

Detailed Answer:
HI, thanks for using healthcare magic

Based on your symptoms, it is likely pleurisy. Inflammation of the pleura can occur as a result of different causes including infection (eg viral or bacterial infection such as cough/cold) or autoimmune diseases (eg rheumatoid ar).

There are also a lot of other causes.

Unfortunately anti inflammatory are the main stay of treatment but since you cannot use these because of the ulcer, you may need a prescription for one of the opioids.
If the coughing is persistent as well, you should consider an over the counter cough suppressant to reduce it if it is only due to common cold.

If you have severe cough and cold , fever and possibly pneumonia, then you need to consider assessment by your doctor and specific treatment for this though some medical studies indicate pleuritic pain can persist 30 days after the pneumonia resolves.

Summary: (1) sounds like pleuritic pain
(2)different causes including infection , autoimmune disease
(3)anti inflammatory meds main stay of treatment but since cannot use then opioids
(4)cough suppressant
(5)if symptoms of pneumonia, need assessment.

I hope this helps, feel free to ask any other questions

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Michelle Gibson James (16 minutes later)

Thank you so much Dr Gibson XXXXXXX for your prompt and detailed answer. I forgot to mention that my blood pressure has been a bit high for me too since the pain started. My BP is usually on the lower side 112/70 often under 100 but the past few days it has been reaching 157/99 at times. Should I be concerned about heart problems? I also have slight peripheral edema with pitting and had this a few months ago and at the ER the doctor thought I had Pericarditis but my bloods were okay so he concluded it was chostochronditis. I had low BP at that time 81/57. So is the higher BP at the moment a sign of possible heart issues like pericarditis?

Answered by Dr. Michelle Gibson James (23 minutes later)

Brief Answer:
it does not mean pericarditis

Detailed Answer:
HI

It is natural to be concerned since your blood pressure is normally a lot lower but increase in blood pressure is not a necessary sign of pericarditis.

Pericarditis is also associated with pain that is worse on inspiration, lying flat, worse on swallowing, relieved by leaning forward.If these are present then you need to be assessed as soon as possible

The increase in blood pressure may be in response to your pain and not indicative of any heart issues but if you remain concerned then you would need to be examined because there are particular sounds that are heard on the chest if there is pericarditis

Please feel free to ask anything else

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Michelle Gibson James (13 minutes later)

Thanks again Dr Gibson XXXXXXX I feel much reassured that it is not Pericarditis since you explained that the pain would most likely be worse on swallowing etc. as I have none of the other symptoms. I suspected the higher BP was pain related but just wanted to be sure. I think it is Pleurisy because I had a slight cold 3 weeks ago and haven't felt great since then. I don't have a productive cough or fever and suspect the RA has contributed to developing the Pleurisy. Bed rest, minimising movement and lifting and heat is helping and your reassurance has definitely relieved my anxiety. Thank you once again for your guidance and reassurance.

Answered by Dr. Michelle Gibson James (16 minutes later)

Brief Answer:
No problem

Detailed Answer:
HI

You can contact at any time with any further queries

Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar