Rheumatoid pleuritis

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Rheumatoid pleuritis
Fibrinous pleuritis overlying subpleural rheumatoid nodules
Synonyms N/A
Pronounce
Field N/A
Symptoms Chest pain, dyspnea, cough, fever, reduced breath sounds
Complications Recurrent effusions, pleural thickening, fibrosis, empyema
Onset Typically in patients with longstanding rheumatoid arthritis
Duration Variable; may resolve or recur
Types
Causes Complication of rheumatoid arthritis
Risks Male sex, older age, high rheumatoid factor titers
Diagnosis Pleural fluid analysis, chest X-ray, CT scan, pleural biopsy
Differential diagnosis Tuberculosis, malignancy, lupus pleuritis, bacterial pneumonia
Prevention Management of underlying rheumatoid arthritis
Treatment Corticosteroids, NSAIDs, pleural drainage, immunosuppressive therapy
Medication Prednisone, methotrexate, hydroxychloroquine
Prognosis Good with treatment, though risk of recurrence exists
Frequency Occurs in ~2–3% of patients with rheumatoid arthritis
Deaths Rare; usually related to complications


Rheumatoid pleuritis is a rare extra-articular manifestation of rheumatoid arthritis (RA), characterized by inflammation of the pleura resulting in a pleural effusion. It occurs in approximately 2–3% of individuals with established RA and is more common in middle-aged to elderly men with seropositive disease.

Clinical Presentation[edit | edit source]

Rheumatoid pleuritis may be asymptomatic or present with signs and symptoms of a pleural effusion, including:

Pleural effusions may be unilateral or bilateral and are typically exudative.

Pathophysiology[edit | edit source]

The pathogenesis of rheumatoid pleuritis involves chronic inflammation of the pleural membrane, driven by autoimmune activity associated with RA. This leads to:

Histopathology[edit | edit source]

Microscopic examination of pleural biopsy specimens reveals:

  • Loss of the mesothelial cell layer
  • Thickening of the pleura
  • Pseudostratified epithelium-like lining composed of immune cells
  • Presence of fibrin, necrotic tissue, and granulomatous inflammation

These features help distinguish rheumatoid pleuritis from other causes of pleuritis such as infection or malignancy.

Diagnosis[edit | edit source]

Diagnosis is based on clinical suspicion in a patient with RA and characteristic pleural fluid analysis findings:

Imaging such as chest X-ray or CT scan confirms the presence of pleural effusion.

Differential Diagnosis[edit | edit source]

Rheumatoid pleuritis must be distinguished from other causes of exudative pleural effusions, including:

Treatment[edit | edit source]

Management involves controlling the underlying RA and reducing inflammation:

Prognosis[edit | edit source]

With appropriate treatment, most patients recover without long-term sequelae. However, recurrent pleural effusions or development of chronic pleural thickening and fibrosis can occur. Rarely, complications such as empyema may develop.

See Also[edit | edit source]

External Links[edit | edit source]



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Contributors: Prab R. Tumpati, MD