Pleural effusions rheumatoid

Extra-articular involvement may include rheumatoid nodules, vasculitis, pleural effusions, pulmonary fibrosis, ocular manifestations, pericarditis, cardiac conduction abnormalities, bone marrow suppression, and lym-phadenopathy. 

Rheumatoid arthritis may involve the pleura of the lung, which is often asymptomatic, although pleural effusions may result. Pulmonary fibrosis also may develop as a result of rheumatoid involvement smoking appears to increase the risk of this complication. Rheumatoid nodules may develop in lung tissue and appear similar to neoplasms on chest x-ray films. Interstitial pneumonitis and arteritis are rare, potentially life-threatening complications of rheumatoid arthritis. 

HRCT often discloses a complex admixture of lesions, termed rheumatoid lung. Bronchiectasis is present in 8% to 75% of patients, but the distinction between primary bronchiectasis and traction bronchiectasis due to pulmonary fibrosis is often difficult (139,140,149,151,152,155,166,177). Bronchiolitis is also frequent, manifesting as centrilobular nodules, tree-in-bud sign, mosaic perfusion, or air trapping (139,149,151,152,155,166,177). Emphysema is present in 5% to 43% of patients (13,139,140,149,151,152,155,166,174,177) and is widely viewed as a trait of RA-ILD, unlike findings in other CTDs. Emphysema is more frequent with an HRCT pattern of UIP, as opposed to NSIP (155). Other features include pulmonary rheumatoid nodules and pleural effusion or thickening can be observed. Pulmonary artery enlargement has been observed in nearly half of patients with RA-ILD, in spite of the fact that overt PH is rare in RA (155). 

The most common CTD throughout the world is rheumatoid arthritis (RA). Thoracic manifestations of RA are numerous (Table 1) including forms of ILD. The thoracic disease manifestations independent of ILD include pleural effusions, bronchiolitis obliterans (BO) without an organizing pneumonia, rheumatoid nodules, upper airway obstruction, and acute rheumatoid pneumonitis. 

Sahn SA. The pathophysiology of pleural effusions. Annu Rev Med 1990 41 7-13. Lillington GA, Carr DT, Ma3fne JG. Rheumatoid pleurisy with effusion. Arch Intern Med 1971 128(5) 764-768. 

Ferguson G. Cholesterol pleural effusion in rheumatoid lung disease. Thorax 1966 ... 

Faurschou P, Francis D, Faarup P. Thoracoscopic, histological, and clinical findings in nine case of rheumatoid pleural effusion. Thorax 1985 40(5) 371-375. 

Four cases of pleural effusion and biopsy-proven pleural amyloid infiltration in patients with AA amyloidosis have been reported in the past 30 years (17-19). Three cases occurred in patients with long-standing rheumatoid arthritis and the remaining patient had cystic fibrosis. No amyloid-related pleural effusions have been reported in FMF. The rarity of pleural effusions in AA amyloidosis is further evidenced by the absence of pleural disease at autopsy in 113 A A patients (14), a registry of 287 Turkish AA patients (36), or autopsies of 7 patients— despite bronchial waU or pulmonary vessel amyloid deposition in over 70% (13). 

Methotrexate is now considered the DMARD of choice by many rheumatologists for treating rheumatoid arthritis. In psoriatic arthritis it not only treats the joint symptoms, but also improves the skin disease for most patients. Methotrexate is contraindicated in pregnant and nursing women. It is also contraindicated in patients with chronic liver disease, immunodeficiency, pleural or peritoneal effusions, leukopenia, thrombocytopenia, pre-existing blood disorders, and a creatinine clearance of less than 40 mL/min. 

Rupture of necrobiotic nodule into pleural space Pleural fibrosis from previous rheumatoid effusion... 

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