Medicine:Rheumatoid pleuritis

Rheumatoid pleuritis
Specialty	Rheumatology
Causes	complication of rheumatoid arthritis

Rheumatoid pleuritis, a form of pleural effusion, is an uncommon complication of rheumatoid arthritis, occurring in 2-3% of patients (Walker and Wright, 1967; Naylor, 1990) Rheumatoid pleura most often appears as an erythematous exanthema, discoloration, or gray discoloration and may grow into a tender, inflamed mass.

Rheumatoid patency is a nonspecific condition characterized by inflammation of the aorta or valve, so as to alter the blood-flow to the aortic valve. Rheumatoid patency typically occurs in older patients, and there is a significant risk for severe, late complications such as aortic valve stenosis, heart valve stenosis.

Presentation

Pleural effusion usually occurs in patients previously diagnosed with rheumatoid arthritis, but it can also occur concurrently with or before the development of the joint manifestations of the disease (Graham, 1990; Chou and Chang, 2002). Patients may present with the signs of pleural effusion: dullness on percussion, diminished or absent breath sounds and vocal fremitus, and egophony at the level of the pleural liquid.

Histopathology

Light microscopy reveals replacement of normal cells lining the pleura (mesothelial cells) by a layer of pseudostratified epithelioid cells, multinucleated giant macrophages, and necrotic material (Mandl et al., 1969; Lillington et al. 1971)

Diagnosis

Diagnosis relies on the characteristic cytopathology of the exudative pleural fluid, which contains elongated and giant multinucleated macrophages in a sea of amorphous granular material. The absence of mesothelial cells is also characteristic (Champion, 1968). While these findings are highly specific for rheumatoid pleuritis (Nosanchuk et al., 1968; Geisinger, 1985; Engel, 1986; Montes, 1988; Shinto, 1988), rheumatoid pleuritis must be considered if more than one of the above cytologic findings are detected.

Treatment

Steroids are the mainstay of treatment for rheumatoid arthritis, and have been shown to improve rheumatoid pleuritis.

References

• "Rheumatoid pleurisy and pericarditis". Ann Rheum Dis 27 (6): 521–30. 1968. doi:10.1136/ard.27.6.521. PMID 4178130. 
• "Pleuritis as a presenting manifestation of rheumatoid arthritis: diagnostic clues in pleural fluid cytology". Am J Med Sci 323 (3): 158–61. 2002. doi:10.1097/00000441-200203000-00008. PMID 11908862. 
• "Rheumatoid pleurisy. Specificity of cytological findings". Acta Pathol Microbiol Immunol Scand A 94 (1): 53–6. 1986. PMID 3962679. 
• "Rheumatoid pleural effusion. A transmission and scanning electron microscopic evaluation". Acta Cytol 29 (3): 239–47. 1985. PMID 3890439. 
• Graham WR (1990). "Rheumatoid pleuritis". South Med J 83 (8): 973–5. doi:10.1097/00007611-199008000-00030. PMID 2200144. 
• "Rheumatoid pleurisy with effusion". Arch Intern Med 128 (5): 764–8. 1971. doi:10.1001/archinte.128.5.764. PMID 5119224. 
• "Pleural fluid in rheumatoid pleuritis. Patient summary with histopathologic studies". Arch Intern Med 124 (3): 373–6. 1969. doi:10.1001/archinte.124.3.373. PMID 4896636. 
• "Cytology of pleural effusions in rheumatoid arthritis". Diagnostic Cytopathology 4 (1): 71–3. 1988. doi:10.1002/dc.2840040117. PMID 3378489. 
• Naylor B (1990). "The pathognomonic cytologic picture of rheumatoid pleuritis. The 1989 Maurice Goldblatt Cytology award lecture". Acta Cytol 34 (4): 465–73. PMID 2197838. 
• "A unique cytologic picture in pleural fluid from patients with rheumatoid arthritis". Am J Clin Pathol 50 (3): 330–5. 1968. doi:10.1093/ajcp/50.3.330. PMID 5676332. 
• "Characteristic cytology in rheumatoid pleural effusion". Am J Med 85 (4): 587–9. 1988. doi:10.1016/0002-9343(88)90665-1. PMID 3177420. 
• "Rheumatoid pleuritis". Ann Rheum Dis 26 (6): 467–74. 1967. doi:10.1136/ard.26.6.467. PMID 6066230.