Rheumatoid pleuritis
From Ask Dr Wiki
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)
Contents |
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)
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
- {{#if:Champion GD, Robertson MR, Robinson RG
|{{#if:
|[[{{{authorlink}}}|{{#if:
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|Champion GD, Robertson MR, Robinson RG
}}]]
|{{#if:
|{{{last}}}{{#if:
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}}
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}}{{#if:Champion GD, Robertson MR, Robinson RG
|{{#if:
| ; {{{coauthors}}}
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}}{{#if:
| ({{{date}}})
|{{#if:1968
|{{#if:
| ({{{month}}} 1968)
| (1968)
}}
}}
}}{{#if:Champion GD, Robertson MR, Robinson RG
| .
}}{{#if:Champion GD, Robertson MR, Robinson RG1968
|
}}{{#ifeq:
| no
|
| {{#if: |“|"}}
}}{{#if:
|[{{{url}}} Rheumatoid pleurisy and pericarditis]
|Rheumatoid pleurisy and pericarditis
}}{{#ifeq:
| no
|
| {{#if:|”|"}}
}}{{#if:
| (in {{{language}}})
}}{{#if:
| ({{{format}}})
}}{{#if:Ann Rheum Dis
|. Ann Rheum Dis
}}{{#if:27
| 27
}}{{#if:6
| (6)
}}{{#if:521-30
|: 521-30
}}{{#if:
|. {{#if:
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|. PMID 4178130
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|. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }}
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- {{#if:Chou CW, Chang SC
|{{#if:
|[[{{{authorlink}}}|{{#if:
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|Chou CW, Chang SC
}}]]
|{{#if:
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}}{{#if:Chou CW, Chang SC
|{{#if:
| ; {{{coauthors}}}
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}}{{#if:
| ({{{date}}})
|{{#if:2002
|{{#if:
| ({{{month}}} 2002)
| (2002)
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}}
}}{{#if:Chou CW, Chang SC
| .
}}{{#if:Chou CW, Chang SC2002
|
}}{{#ifeq:
| no
|
| {{#if: |“|"}}
}}{{#if:
|[{{{url}}} Pleuritis as a presenting manifestation of rheumatoid arthritis: diagnostic clues in pleural fluid cytology]
|Pleuritis as a presenting manifestation of rheumatoid arthritis: diagnostic clues in pleural fluid cytology
}}{{#ifeq:
| no
|
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|. Am J Med Sci
}}{{#if:323
| 323
}}{{#if:3
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|: 158-61
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}}{{#if:PMID 11908862
|. PMID 11908862
}}{{#if:
|. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }}
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- {{#if:Engel U, Aru A, Francis D
|{{#if:
|[[{{{authorlink}}}|{{#if:
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|Engel U, Aru A, Francis D
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}}{{#if:Engel U, Aru A, Francis D
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| ; {{{coauthors}}}
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}}{{#if:
| ({{{date}}})
|{{#if:1986
|{{#if:
| ({{{month}}} 1986)
| (1986)
}}
}}
}}{{#if:Engel U, Aru A, Francis D
| .
}}{{#if:Engel U, Aru A, Francis D1986
|
}}{{#ifeq:
| no
|
| {{#if: |“|"}}
}}{{#if:
|[{{{url}}} Rheumatoid pleurisy. Specificity of cytological findings]
|Rheumatoid pleurisy. Specificity of cytological findings
}}{{#ifeq:
| no
|
| {{#if:|”|"}}
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| (in {{{language}}})
}}{{#if:
| ({{{format}}})
}}{{#if:Acta Pathol Microbiol Immunol Scand [A]
|. Acta Pathol Microbiol Immunol Scand [A]
}}{{#if:94
| 94
}}{{#if:1
| (1)
}}{{#if:53-6
|: 53-6
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}}{{#if:PMID 3962679
|. PMID 3962679
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- {{#if:Geisinger KR, Vance RP, Prater T, Semble E, Pisko EJ
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}}{{#if:Geisinger KR, Vance RP, Prater T, Semble E, Pisko EJ
|{{#if:
| ; {{{coauthors}}}
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}}{{#if:
| ({{{date}}})
|{{#if:1985
|{{#if:
| ({{{month}}} 1985)
| (1985)
}}
}}
}}{{#if:Geisinger KR, Vance RP, Prater T, Semble E, Pisko EJ
| .
}}{{#if:Geisinger KR, Vance RP, Prater T, Semble E, Pisko EJ1985
|
}}{{#ifeq:
| no
|
| {{#if: |“|"}}
}}{{#if:
|[{{{url}}} Rheumatoid pleural effusion. A transmission and scanning electron microscopic evaluation]
|Rheumatoid pleural effusion. A transmission and scanning electron microscopic evaluation
}}{{#ifeq:
| no
|
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}}{{#if:
| ({{{format}}})
}}{{#if:Acta Cytol
|. Acta Cytol
}}{{#if:29
| 29
}}{{#if:3
| (3)
}}{{#if:239-47
|: 239-47
}}{{#if:
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}}{{#if:PMID 3890439
|. PMID 3890439
}}{{#if:
|. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }}
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- {{#if:Graham WR
|{{#if:
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}}{{#if:Graham WR
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}}{{#if:
| ({{{date}}})
|{{#if:1990
|{{#if:
| ({{{month}}} 1990)
| (1990)
}}
}}
}}{{#if:Graham WR
| .
}}{{#if:Graham WR1990
|
}}{{#ifeq:
| no
|
| {{#if: |“|"}}
}}{{#if:
|[{{{url}}} Rheumatoid pleuritis]
|Rheumatoid pleuritis
}}{{#ifeq:
| no
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| ({{{format}}})
}}{{#if:South Med J
|. South Med J
}}{{#if:83
| 83
}}{{#if:8
| (8)
}}{{#if:973-5
|: 973-5
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}}{{#if:PMID 2200144
|. PMID 2200144
}}{{#if:
|. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }}
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- {{#if:Lillington GA, Carr DT, Mayne JG
|{{#if:
|[[{{{authorlink}}}|{{#if:
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|Lillington GA, Carr DT, Mayne JG
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}}{{#if:Lillington GA, Carr DT, Mayne JG
|{{#if:
| ; {{{coauthors}}}
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}}{{#if:
| ({{{date}}})
|{{#if:1971
|{{#if:
| ({{{month}}} 1971)
| (1971)
}}
}}
}}{{#if:Lillington GA, Carr DT, Mayne JG
| .
}}{{#if:Lillington GA, Carr DT, Mayne JG1971
|
}}{{#ifeq:
| no
|
| {{#if: |“|"}}
}}{{#if:
|[{{{url}}} Rheumatoid pleurisy with effusion]
|Rheumatoid pleurisy with effusion
}}{{#ifeq:
| no
|
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| (in {{{language}}})
}}{{#if:
| ({{{format}}})
}}{{#if:Arch Intern Med
|. Arch Intern Med
}}{{#if:128
| 128
}}{{#if:5
| (5)
}}{{#if:764-8
|: 764-8
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}}{{#if:PMID 5119224
|. PMID 5119224
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- {{#if:Mandl MA, Watson JI, Henderson JA, Wang N
|{{#if:
|[[{{{authorlink}}}|{{#if:
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|Mandl MA, Watson JI, Henderson JA, Wang N
}}]]
|{{#if:
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|Mandl MA, Watson JI, Henderson JA, Wang N
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}}{{#if:Mandl MA, Watson JI, Henderson JA, Wang N
|{{#if:
| ; {{{coauthors}}}
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}}{{#if:
| ({{{date}}})
|{{#if:1969
|{{#if:
| ({{{month}}} 1969)
| (1969)
}}
}}
}}{{#if:Mandl MA, Watson JI, Henderson JA, Wang N
| .
}}{{#if:Mandl MA, Watson JI, Henderson JA, Wang N1969
|
}}{{#ifeq:
| no
|
| {{#if: |“|"}}
}}{{#if:
|[{{{url}}} Pleural fluid in rheumatoid pleuritis. Patient summary with histopathologic studies]
|Pleural fluid in rheumatoid pleuritis. Patient summary with histopathologic studies
}}{{#ifeq:
| no
|
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|. Arch Intern Med
}}{{#if:124
| 124
}}{{#if:3
| (3)
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|: 373-6
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}}{{#if:PMID 4896636
|. PMID 4896636
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- {{#if:Montes S, Guarda LA
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}}{{#if:Montes S, Guarda LA
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}}{{#if:
| ({{{date}}})
|{{#if:1988
|{{#if:
| ({{{month}}} 1988)
| (1988)
}}
}}
}}{{#if:Montes S, Guarda LA
| .
}}{{#if:Montes S, Guarda LA1988
|
}}{{#ifeq:
| no
|
| {{#if: |“|"}}
}}{{#if:
|[{{{url}}} Cytology of pleural effusions in rheumatoid arthritis]
|Cytology of pleural effusions in rheumatoid arthritis
}}{{#ifeq:
| no
|
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| (in {{{language}}})
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| ({{{format}}})
}}{{#if:Diagn Cytopathol
|. Diagn Cytopathol
}}{{#if:4
| 4
}}{{#if:1
| (1)
}}{{#if:71-3
|: 71-3
}}{{#if:
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}}{{#if:PMID 3378489
|. PMID 3378489
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- {{#if:Naylor B
|{{#if:
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}}{{#if:Naylor B
|{{#if:
| ; {{{coauthors}}}
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}}{{#if:
| ({{{date}}})
|{{#if:1990
|{{#if:
| ({{{month}}} 1990)
| (1990)
}}
}}
}}{{#if:Naylor B
| .
}}{{#if:Naylor B1990
|
}}{{#ifeq:
| no
|
| {{#if: |“|"}}
}}{{#if:
|[{{{url}}} The pathognomonic cytologic picture of rheumatoid pleuritis. The 1989 Maurice Goldblatt Cytology award lecture]
|The pathognomonic cytologic picture of rheumatoid pleuritis. The 1989 Maurice Goldblatt Cytology award lecture
}}{{#ifeq:
| no
|
| {{#if:|”|"}}
}}{{#if:
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}}{{#if:
| ({{{format}}})
}}{{#if:Acta Cytol
|. Acta Cytol
}}{{#if:34
| 34
}}{{#if:4
| (4)
}}{{#if:465-73
|: 465-73
}}{{#if:
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}}{{#if:PMID 2197838
|. PMID 2197838
}}{{#if:
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- {{#if:Nosanchuk JS, Naylor B
|{{#if:
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|Nosanchuk JS, Naylor B
}}]]
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}}{{#if:Nosanchuk JS, Naylor B
|{{#if:
| ; {{{coauthors}}}
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}}{{#if:
| ({{{date}}})
|{{#if:1968
|{{#if:
| ({{{month}}} 1968)
| (1968)
}}
}}
}}{{#if:Nosanchuk JS, Naylor B
| .
}}{{#if:Nosanchuk JS, Naylor B1968
|
}}{{#ifeq:
| no
|
| {{#if: |“|"}}
}}{{#if:
|[{{{url}}} A unique cytologic picture in pleural fluid from patients with rheumatoid arthritis]
|A unique cytologic picture in pleural fluid from patients with rheumatoid arthritis
}}{{#ifeq:
| no
|
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| ({{{format}}})
}}{{#if:Am J Clin Pathol
|. Am J Clin Pathol
}}{{#if:50
| 50
}}{{#if:3
| (3)
}}{{#if:330-5
|: 330-5
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}}{{#if:PMID 5676332
|. PMID 5676332
}}{{#if:
|. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }}
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- {{#if:Shinto R, Prete P
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|Shinto R, Prete P
}}]]
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}}{{#if:Shinto R, Prete P
|{{#if:
| ; {{{coauthors}}}
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}}{{#if:
| ({{{date}}})
|{{#if:1988
|{{#if:
| ({{{month}}} 1988)
| (1988)
}}
}}
}}{{#if:Shinto R, Prete P
| .
}}{{#if:Shinto R, Prete P1988
|
}}{{#ifeq:
| no
|
| {{#if: |“|"}}
}}{{#if:
|[{{{url}}} Characteristic cytology in rheumatoid pleural effusion]
|Characteristic cytology in rheumatoid pleural effusion
}}{{#ifeq:
| no
|
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|. Am J Med
}}{{#if:85
| 85
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|: 587-9
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}}{{#if:PMID 3177420
|. PMID 3177420
}}{{#if:
|. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }}
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}}{{#if:
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|{{#if:1967
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}}{{#if:Walker WC, Wright V1967
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}}{{#if:
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}}{{#if:Ann Rheum Dis
|. Ann Rheum Dis
}}{{#if:26
| 26
}}{{#if:6
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}}{{#if:467-74
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}}{{#if:PMID 6066230
|. PMID 6066230
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