Rheumatoid pleuritis 3976032 215524807 2008-05-28T16:11:11Z DOI bot 6652755 Citation maintenance. You can [[WP:DOI|use this bot]] yourself! Please [[User:DOI_bot/bugs|report any bugs]]. '''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) ==Histopathology== Light microscopy reveals replacement of normal cells lining the pleura ([[Mesothelium|mesothelial cells]]) by a layer of pseudostratified epithelioid cells, [[multinucleated]] giant [[macrophage]]s, and [[necrotic]] material (Mandl et al, 1969; Lillington et al 1971) ==Clinical Characteristics== 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. ==Diagnosis== Diagnosis relies on the characteristic [[cytology]] 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== * {{cite journal | author=Champion GD, Robertson MR, Robinson RG | title=Rheumatoid pleurisy and pericarditis | journal=Ann Rheum Dis | year=1968 | pages=521–30 | volume=27 | issue=6 | pmid=4178130}} * {{cite journal | author=Chou CW, Chang SC | title=Pleuritis as a presenting manifestation of rheumatoid arthritis: diagnostic clues in pleural fluid cytology | journal=Am J Med Sci | year=2002 | pages=158–61 | volume=323 | issue=3 | pmid=11908862 | doi=10.1097/00000441-200203000-00008}} * {{cite journal | author=Engel U, Aru A, Francis D | title=Rheumatoid pleurisy. Specificity of cytological findings | journal=Acta Pathol Microbiol Immunol Scand [A] | year=1986 | pages=53–6 | volume=94 | issue=1 | pmid=3962679}} * {{cite journal | author=Geisinger KR, Vance RP, Prater T, Semble E, Pisko EJ | title=Rheumatoid pleural effusion. A transmission and scanning electron microscopic evaluation | journal=Acta Cytol | year=1985 | pages=239–47 | volume=29 | issue=3 | pmid=3890439}} * {{cite journal | author=Graham WR | title=Rheumatoid pleuritis | journal=South Med J | year=1990 | pages=973–5 | volume=83 | issue=8 | pmid=2200144}} * {{cite journal | author=Lillington GA, Carr DT, Mayne JG | title=Rheumatoid pleurisy with effusion | journal=Arch Intern Med | year=1971 | pages=764–8 | volume=128 | issue=5 | pmid=5119224 | doi=10.1001/archinte.128.5.764}} * {{cite journal | author=Mandl MA, Watson JI, Henderson JA, Wang N | title=Pleural fluid in rheumatoid pleuritis. Patient summary with histopathologic studies | journal=Arch Intern Med | year=1969 | pages=373–6 | volume=124 | issue=3 | pmid=4896636 | doi=10.1001/archinte.124.3.373}} * {{cite journal | author=Montes S, Guarda LA | title=Cytology of pleural effusions in rheumatoid arthritis | journal=Diagn Cytopathol | year=1988 | pages=71–3 | volume=4 | issue=1 | pmid=3378489 | doi=10.1002/dc.2840040117}} * {{cite journal | author=Naylor B | title=The pathognomonic cytologic picture of rheumatoid pleuritis. The 1989 Maurice Goldblatt Cytology award lecture | journal=Acta Cytol | year=1990 | pages=465–73 | volume=34 | issue=4 | pmid=2197838}} * {{cite journal | author=Nosanchuk JS, Naylor B | title=A unique cytologic picture in pleural fluid from patients with rheumatoid arthritis | journal=Am J Clin Pathol | year=1968 | pages=330–5 | volume=50 | issue=3 | pmid=5676332}} * {{cite journal | author=Shinto R, Prete P | title=Characteristic cytology in rheumatoid pleural effusion | journal=Am J Med | year=1988 | pages=587–9 | volume=85 | issue=4 | pmid=3177420 | doi=10.1016/0002-9343(88)90665-1}} * {{cite journal | author=Walker WC, Wright V | title=Rheumatoid pleuritis | journal=Ann Rheum Dis | year=1967 | pages=467–74 | volume=26 | issue=6 | pmid=6066230}} [[Category:Pulmonology]] [[Category:Rheumatology]]