Rheumatoid Pleural Effusion
Section snippets
Methods
This review is based on a MEDLINE (PubMed) search of the English literature from 1964 to 2005, using the keywords “rheumatoid arthritis,” “pulmonary complication,” “pleural effusion,” and “pleural empyema.” The search included studies concerning the diagnosis of rheumatoid pleural effusion (RPE), the usefulness of different diagnostic procedures, and treatment modalities. We reviewed 83 articles focused exclusively on pleural exudate in RA. As no randomized placebo-controlled studies have been
Epidemiology of RPE
The annual incidence of RPE in the RA population is 0.34% in women (157) and 1.54% in men (77) (10). It has been found in 9/1200 thoracoscopic biopsies (0.75%) performed for pleural effusion of different causes (11). Symptomatic pleural effusion has been described in 3 to 5% of RA patients, but pleural involvement on plain chest radiograms is much higher. Sequelae of pleurisy (pleural thickening and/or effusion) were found in 24% of men and 16% of women in 309 chest radiographs of RA patients (7
Discussion
Inflammatory pleural effusion is a common feature of RA, especially in a subgroup of middle-aged men with positive RF and a tendency to rheumatoid nodules. In most cases, RPE is small and asymptomatic, and there is no need for intervention. Large amounts of pleural fluid may compromise respiratory function and require aspiration to allow underlying lung expansion. Symptomatic or significant amounts of pleural effusion should be drained, preferably guided by US or CT. RPE has prominent signs of
Acknowledgment
The authors thank M. Perlmutter for help in the preparation of this article.
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