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Related Experiment Videos

Rheumatoid pleural effusion.

Alexandra Balbir-Gurman1, Mordechai Yigla, Abraham Menahem Nahir

  • 1B. Shine Department of Rheumatology, Rambam Medical Center, Haifa, Israel. a_balbir@rambam.health.gov.il

Seminars in Arthritis and Rheumatism
|June 13, 2006
PubMed
Summary

Rheumatoid pleural effusion (RPE) is common in men with rheumatoid arthritis (RA) and positive rheumatoid factor. While often resolving spontaneously, symptomatic RPE may require intervention, and rarely progresses to sterile empyema.

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Area of Science:

  • Rheumatology
  • Pulmonology
  • Internal Medicine

Background:

  • Rheumatoid pleural effusion (RPE) is a recognized pulmonary complication of rheumatoid arthritis (RA).
  • Understanding its clinical and laboratory features is crucial for diagnosis and management.

Purpose of the Study:

  • To delineate the clinical and laboratory characteristics of RPE.
  • To review diagnostic and therapeutic strategies for RPE.

Main Methods:

  • A comprehensive literature review was conducted using MEDLINE (PubMed).
  • Search terms included "rheumatoid arthritis", "pulmonary complication", "pleural effusion", and "empyema".
  • The review covered English literature from 1964 to 2005.

Main Results:

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  • RPE is more prevalent in middle-aged men with RA and positive rheumatoid factor (RF), presenting as an exudate with high RF titers.
  • While typically small and self-resolving, symptomatic RPE may necessitate thoracocentesis.
  • Rarely, RPE can manifest as a sterile empyematous exudate with specific biochemical markers, potentially leading to fibrothorax and restrictive lung disease. Superimposed infection is also a concern.

Conclusions:

  • RPE can progress to sterile empyema and fibrothorax.
  • Thoracocentesis is indicated for symptomatic effusions or when infection/malignancy is suspected.
  • Pleural biopsy is essential in non-arthritic patients with "rheumatoid" exudate to rule out tuberculosis or malignancy.
  • Optimal RPE therapy remains undetermined, and the role of cytokines warrants further investigation.