Rheumatoid arthritis pleural effusions

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. 

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. 

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. 

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). 

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