[A case of rheumatoid arthritis accompanied by repeated pleural effusion associated with rapid tapering of steroid]

A 65-year-old woman was referred to our department because of general fatigue and anorexia for one month. The patient has received anti-rheumatoid therapy with aurothiomalate and bucillamine for the last two years for rheumatoid arthritis diagnosed 11 years earlier. Based on her systemic arthralgia, positive RA factor, and characteristic pleural effusion, the diagnosis of rheumatoid pleural effusion was made and prednisolone was administered. Two weeks later, the pleural effusion had improved. Rapid tapering of the drug over one month resulted in reappearance of pleural effusion. Slow tapering of prednisolone resulted in disappearance of the pleural effusion. One year after discharge, the patient was again referred to our department because of increased arthralgia. Pleural effusion reappeared after similar rapid tapering of the drug. These results suggest that induction of pleural effusion may occur in rheumatoid arthritis patients as a result of rapid tapering of steroids. Tapering of steroids in rheumatoid patients should be performed with care.