Thoracoscopic, histological, and clinical findings in nine case of rheumatoid pleural effusion.

Back pain in a 59-year-old woman with rheumatoid arthritis

“…5 Another study found that pleural effusions in all nine patients resolved within an average of 14 (range 1-36) months. 6 The outcome was similar in our case, with spontaneous resolution in three months.…”

“…7,9 The parietal pleura has been found to show characteristic features on thoracoscopic and histologic examination. 6 In our patient, the tissue from the pleural biopsy was examined carefully several times, and only nonspecific inflammatory changes were found.…”

Rheumatoid arthritis-associated lung disease

“…In rheumatoid pleuritis, the parietal pleural is thickened with a "gritty" granular appearance. On histology, there is replacement of the normal mesothelial lining with multinucleated giant cells and foci of palisading fibroblasts and lymphocytes surrounding necrotic centres, similar to rheumatoid nodules [52,53].…”

“…) and elevated lactate dehydrogenase (may be >700 IU·L ) [50,51,53]. Low pH results from elevated glucose metabolism in the inflamed pleural space, with resultant production of lactate and carbon dioxide [50,52].…”

Pleuro-Pulmonary Complications of Rheumatoid Arthritis

“…In cases of rheumatoid pleuritis both the "gritty" frozen macroscopic appearance of the pleura and histopathology are classically diagnostic. 17,18 Most rheumatoid effusions are ultimately self-limiting with over twothirds resolving within 4 months of their diagnosis. 9 RA-associated pleural effusion shares many biochemical and macroscopic features with empyema, and the clinical history should be considered alongside appropriate microbiological studies before starting treatment for infection.…”