Rheumatoid pleural effusion: lack of response to intrapleural corticosteroid

Two cases of rheumatoid arthritis with large persistent, asymptomatic pleural effusions are presented. Repeated thoracentesis and intrapleural instillation of corticosteroid proved ineffective in management. However, the persistence of the effusion did not result in any respiratory complications. In one case the effusion disappeared spontaneously long after articular disease remitted, and in neither case did the size of the effusion parallel articular disease activity. It would appear that treatment directed solely at elimination of large rheumatoid pleural effusions is both unrewarding and unnecessary, as long as the underlying lung is normal.