Rheumatoid pleuritis: Difference between revisions
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{{Infobox medical condition (new) | {{Infobox medical condition (new) | ||
| name = | | name = Rheumatoid pleuritis | ||
| synonym = | | synonym = Rheumatoid pleural effusion | ||
| image = | | image = Fibrinous pleuritis overlying subpleural rheumatoid nodules (4864373998).jpg | ||
| image_size = | | image_size = 250px | ||
| alt = | | alt = Fibrinous pleuritis overlying subpleural rheumatoid nodules | ||
| caption = | | caption = Fibrinous pleuritis overlying subpleural rheumatoid nodules | ||
| pronounce = | | pronounce = | ||
| specialty = | | specialty = [[Rheumatology]], [[Pulmonology]] | ||
| symptoms = | | symptoms = Chest pain, dyspnea, cough, fever, reduced breath sounds | ||
| complications = | | complications = Recurrent effusions, [[pleural thickening]], fibrosis, empyema | ||
| onset = | | onset = Typically in patients with longstanding [[rheumatoid arthritis]] | ||
| duration = | | duration = Variable; may resolve or recur | ||
| types = | | types = | ||
| causes = | | causes = Complication of [[rheumatoid arthritis]] | ||
| risks = | | risks = Male sex, older age, high rheumatoid factor titers | ||
| diagnosis = | | diagnosis = [[Pleural fluid analysis]], [[chest X-ray]], [[CT scan]], [[pleural biopsy]] | ||
| differential = | | differential = [[Tuberculosis]], [[malignancy]], [[lupus pleuritis]], [[bacterial pneumonia]] | ||
| prevention = | | prevention = Management of underlying rheumatoid arthritis | ||
| treatment = | | treatment = [[Corticosteroids]], [[NSAIDs]], [[pleural drainage]], [[immunosuppressive therapy]] | ||
| medication = | | medication = Prednisone, methotrexate, hydroxychloroquine | ||
| prognosis = | | prognosis = Good with treatment, though risk of recurrence exists | ||
| frequency = | | frequency = Occurs in ~2–3% of patients with rheumatoid arthritis | ||
| deaths = | | 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 == | ||
Rheumatoid pleuritis may be asymptomatic or present with signs and symptoms of a [[pleural effusion]], including: | |||
* [[Pleuritic chest pain]] | |||
* [[Dyspnea]] | |||
* Nonproductive cough | |||
* [[Fever]] | |||
* Decreased breath sounds on auscultation | |||
* Dullness to percussion | |||
* Decreased or absent [[vocal fremitus]] | |||
* [[Egophony]] at the upper fluid level | |||
Pleural effusions may be unilateral or bilateral and are typically exudative. | |||
== | == Pathophysiology == | ||
The pathogenesis of rheumatoid pleuritis involves chronic inflammation of the pleural membrane, driven by autoimmune activity associated with RA. This leads to: | |||
* Accumulation of pleural fluid | |||
* Replacement of normal [[mesothelial cells]] by pseudostratified epithelioid cells | |||
* Infiltration by [[multinucleated giant cells]] and [[macrophages]] | |||
* Fibrinous and necrotic debris within the pleural space | |||
== | == Histopathology == | ||
* | 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 == | ||
* | Diagnosis is based on clinical suspicion in a patient with RA and characteristic pleural fluid analysis findings: | ||
* | * [[Pleural fluid]] is exudative (per [[Light's criteria]]) | ||
* Low [[glucose]] concentration (<30 mg/dL) | |||
* Low [[pH]] (<7.2) | |||
* High [[lactate dehydrogenase]] (LDH) | |||
* High [[rheumatoid factor]] titers | |||
* Absence of mesothelial cells on cytology | |||
* Presence of multinucleated giant cells and granular necrotic debris | |||
Imaging such as [[chest X-ray]] or [[CT scan]] confirms the presence of pleural effusion. | |||
== Differential Diagnosis == | |||
Rheumatoid pleuritis must be distinguished from other causes of exudative pleural effusions, including: | |||
* [[Tuberculous pleuritis]] | |||
* [[Malignant pleural effusion]] | |||
* [[Systemic lupus erythematosus]] (SLE) | |||
* [[Parapneumonic effusion]] or [[empyema]] | |||
== Treatment == | |||
Management involves controlling the underlying RA and reducing inflammation: | |||
* [[Corticosteroids]] (e.g., prednisone) are the mainstay of treatment | |||
* [[Non-steroidal anti-inflammatory drugs]] (NSAIDs) may provide symptom relief | |||
* [[Immunosuppressive agents]] such as [[methotrexate]] or [[hydroxychloroquine]] | |||
* Therapeutic [[thoracentesis]] may be required for symptomatic relief in large effusions | |||
* [[Pleurodesis]] or surgical intervention may be necessary in recurrent or complicated cases | |||
== Prognosis == | |||
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 == | |||
* [[Rheumatoid arthritis]] | |||
* [[Pleural effusion]] | |||
* [[Pleuritis]] | |||
* [[Autoimmune disease]] | |||
* [[Serositis]] | |||
== External Links == | |||
{{Medical resources | |||
| DiseasesDB = 11644 | |||
| ICD10 = M05.10 | |||
| ICD9 = 714.81 | |||
| OMIM = | |||
| MedlinePlus = | |||
| eMedicineSubj = med | |||
| eMedicineTopic = 2039 | |||
| MeshID = D010998 | |||
}} | |||
[[Category:Diseases of pleura]] | [[Category:Diseases of pleura]] | ||
[[Category:Rheumatology]] | [[Category:Rheumatology]] | ||
[[Category:Autoimmune diseases]] | |||
[[Category:Lung disorders]] | |||
{{disease-stub}} | |||
Latest revision as of 01:22, 3 April 2025
| Rheumatoid pleuritis | |
|---|---|
.jpg)
| |
| 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]
Rheumatoid pleuritis may be asymptomatic or present with signs and symptoms of a pleural effusion, including:
- Pleuritic chest pain
- Dyspnea
- Nonproductive cough
- Fever
- Decreased breath sounds on auscultation
- Dullness to percussion
- Decreased or absent vocal fremitus
- Egophony at the upper fluid level
Pleural effusions may be unilateral or bilateral and are typically exudative.
Pathophysiology[edit]
The pathogenesis of rheumatoid pleuritis involves chronic inflammation of the pleural membrane, driven by autoimmune activity associated with RA. This leads to:
- Accumulation of pleural fluid
- Replacement of normal mesothelial cells by pseudostratified epithelioid cells
- Infiltration by multinucleated giant cells and macrophages
- Fibrinous and necrotic debris within the pleural space
Histopathology[edit]
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]
Diagnosis is based on clinical suspicion in a patient with RA and characteristic pleural fluid analysis findings:
- Pleural fluid is exudative (per Light's criteria)
- Low glucose concentration (<30 mg/dL)
- Low pH (<7.2)
- High lactate dehydrogenase (LDH)
- High rheumatoid factor titers
- Absence of mesothelial cells on cytology
- Presence of multinucleated giant cells and granular necrotic debris
Imaging such as chest X-ray or CT scan confirms the presence of pleural effusion.
Differential Diagnosis[edit]
Rheumatoid pleuritis must be distinguished from other causes of exudative pleural effusions, including:
- Tuberculous pleuritis
- Malignant pleural effusion
- Systemic lupus erythematosus (SLE)
- Parapneumonic effusion or empyema
Treatment[edit]
Management involves controlling the underlying RA and reducing inflammation:
- Corticosteroids (e.g., prednisone) are the mainstay of treatment
- Non-steroidal anti-inflammatory drugs (NSAIDs) may provide symptom relief
- Immunosuppressive agents such as methotrexate or hydroxychloroquine
- Therapeutic thoracentesis may be required for symptomatic relief in large effusions
- Pleurodesis or surgical intervention may be necessary in recurrent or complicated cases
Prognosis[edit]
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]
External Links[edit]
