Pleural effusion associated with rheumatoid arthritis: what cell predominance to anticipate?
Pleural involvement is the most frequent manifestation of rheumatoid arthritis (RA) in the chest. We report here two patients who presented with large exudative pleural effusions and subsequently developed sero-positive RA. In both cases, the differential cell count of the pleural effusion suggested...
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Veröffentlicht in: | Rheumatology international 2007-08, Vol.27 (10), p.919-925 |
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description | Pleural involvement is the most frequent manifestation of rheumatoid arthritis (RA) in the chest. We report here two patients who presented with large exudative pleural effusions and subsequently developed sero-positive RA. In both cases, the differential cell count of the pleural effusion suggested empyema. A literature review identified that RA-associated pleural effusion afflicts more men than women and 95% of the patients have high titers of rheumatoid factor (RF). In 46% of cases, RA-associated pleural effusion is diagnosed in close temporal relationship with the diagnosis of RA. The effusion is an exudate and is characterized by low pH and glucose level, and high lactic dehydrogenase (LDH) and cell count. At diagnosis there is a tendency for predominant neutrophils to occur consistent with an empyema and 7-11 days later, the cells in the pleural effusion are replaced by lymphocytes. Pleural effusion with predominant eosinophilia is rare. RA patients with acidic effusion and low glucose content with neutrophils predominance should be treated with thoracic drainage and antibiotics until an infection is ruled out. The histo-pathologic findings in pleural fluid of tadpole cells and multinucleated giant cells and the replacement of the mesothelial cells on the parietal pleural surface with a palisade of macrophage derived cells are described as pathogonomic for RA. Treatment with systemic steroids and intra-pleural steroids are effective in most cases. |
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We report here two patients who presented with large exudative pleural effusions and subsequently developed sero-positive RA. In both cases, the differential cell count of the pleural effusion suggested empyema. A literature review identified that RA-associated pleural effusion afflicts more men than women and 95% of the patients have high titers of rheumatoid factor (RF). In 46% of cases, RA-associated pleural effusion is diagnosed in close temporal relationship with the diagnosis of RA. The effusion is an exudate and is characterized by low pH and glucose level, and high lactic dehydrogenase (LDH) and cell count. At diagnosis there is a tendency for predominant neutrophils to occur consistent with an empyema and 7-11 days later, the cells in the pleural effusion are replaced by lymphocytes. Pleural effusion with predominant eosinophilia is rare. RA patients with acidic effusion and low glucose content with neutrophils predominance should be treated with thoracic drainage and antibiotics until an infection is ruled out. The histo-pathologic findings in pleural fluid of tadpole cells and multinucleated giant cells and the replacement of the mesothelial cells on the parietal pleural surface with a palisade of macrophage derived cells are described as pathogonomic for RA. Treatment with systemic steroids and intra-pleural steroids are effective in most cases.</description><identifier>ISSN: 0172-8172</identifier><identifier>EISSN: 1437-160X</identifier><identifier>DOI: 10.1007/s00296-007-0322-9</identifier><identifier>PMID: 17294192</identifier><language>eng</language><publisher>Germany: Springer Nature B.V</publisher><subject>Aged ; Arthritis, Rheumatoid - complications ; Arthritis, Rheumatoid - diagnosis ; Arthritis, Rheumatoid - drug therapy ; Empyema, Pleural - immunology ; Eosinophilia - drug therapy ; Eosinophilia - immunology ; Humans ; Male ; Medical diagnosis ; Middle Aged ; Pediatrics ; Pleural Effusion - drug therapy ; Pleural Effusion - etiology ; Pleural Effusion - pathology ; Rheumatoid arthritis ; Steroids - therapeutic use</subject><ispartof>Rheumatology international, 2007-08, Vol.27 (10), p.919-925</ispartof><rights>Springer-Verlag 2007.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c326t-6bfc913f7c8e6de2ed3163dee77254aa0c6eb96e69a5709a782381ce88e939113</citedby><cites>FETCH-LOGICAL-c326t-6bfc913f7c8e6de2ed3163dee77254aa0c6eb96e69a5709a782381ce88e939113</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17294192$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Avnon, L Sølling</creatorcontrib><creatorcontrib>Abu-Shakra, M</creatorcontrib><creatorcontrib>Flusser, D</creatorcontrib><creatorcontrib>Heimer, D</creatorcontrib><creatorcontrib>Sion-Vardy, N</creatorcontrib><title>Pleural effusion associated with rheumatoid arthritis: what cell predominance to anticipate?</title><title>Rheumatology international</title><addtitle>Rheumatol Int</addtitle><description>Pleural involvement is the most frequent manifestation of rheumatoid arthritis (RA) in the chest. We report here two patients who presented with large exudative pleural effusions and subsequently developed sero-positive RA. In both cases, the differential cell count of the pleural effusion suggested empyema. A literature review identified that RA-associated pleural effusion afflicts more men than women and 95% of the patients have high titers of rheumatoid factor (RF). In 46% of cases, RA-associated pleural effusion is diagnosed in close temporal relationship with the diagnosis of RA. The effusion is an exudate and is characterized by low pH and glucose level, and high lactic dehydrogenase (LDH) and cell count. At diagnosis there is a tendency for predominant neutrophils to occur consistent with an empyema and 7-11 days later, the cells in the pleural effusion are replaced by lymphocytes. Pleural effusion with predominant eosinophilia is rare. RA patients with acidic effusion and low glucose content with neutrophils predominance should be treated with thoracic drainage and antibiotics until an infection is ruled out. The histo-pathologic findings in pleural fluid of tadpole cells and multinucleated giant cells and the replacement of the mesothelial cells on the parietal pleural surface with a palisade of macrophage derived cells are described as pathogonomic for RA. Treatment with systemic steroids and intra-pleural steroids are effective in most cases.</description><subject>Aged</subject><subject>Arthritis, Rheumatoid - complications</subject><subject>Arthritis, Rheumatoid - diagnosis</subject><subject>Arthritis, Rheumatoid - drug therapy</subject><subject>Empyema, Pleural - immunology</subject><subject>Eosinophilia - drug therapy</subject><subject>Eosinophilia - immunology</subject><subject>Humans</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Middle Aged</subject><subject>Pediatrics</subject><subject>Pleural Effusion - drug therapy</subject><subject>Pleural Effusion - etiology</subject><subject>Pleural Effusion - pathology</subject><subject>Rheumatoid arthritis</subject><subject>Steroids - therapeutic use</subject><issn>0172-8172</issn><issn>1437-160X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNpdUE1LAzEUDKLYWv0BXiR48Laaj22y8SJS_IKCHhQ8CCHNvqUpu5uaZCn-e1NaELy8N-8xMwyD0Dkl15QQeRMJYUoUGRaEM1aoAzSmJZcFFeTzEI0Jlayo8hihkxhXJN9CkGM0yi9VUsXG6OuthSGYFkPTDNH5HpsYvXUmQY03Li1xWMLQmeRdjU1Iy-CSi7d4szQJW2hbvA5Q-871preAk8emT866dTa4O0VHjWkjnO33BH08PrzPnov569PL7H5eWM5EKsSisYryRtoKRA0Mak4FrwGkZNPSGGIFLJQAocxUEmVkxXhFLVQVKK4o5RN0tfNdB_89QEy6c3EbzvTgh6glkZJzwjPx8h9x5YfQ52y6qkrKKWNlJtEdyQYfY4BGr4PrTPjRlOht73rXu97Cbe9aZc3F3nhYdFD_KfZF819nd36m</recordid><startdate>200708</startdate><enddate>200708</enddate><creator>Avnon, L Sølling</creator><creator>Abu-Shakra, M</creator><creator>Flusser, D</creator><creator>Heimer, D</creator><creator>Sion-Vardy, N</creator><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>200708</creationdate><title>Pleural effusion associated with rheumatoid arthritis: what cell predominance to anticipate?</title><author>Avnon, L Sølling ; Abu-Shakra, M ; Flusser, D ; Heimer, D ; Sion-Vardy, N</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-6bfc913f7c8e6de2ed3163dee77254aa0c6eb96e69a5709a782381ce88e939113</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Aged</topic><topic>Arthritis, Rheumatoid - complications</topic><topic>Arthritis, Rheumatoid - diagnosis</topic><topic>Arthritis, Rheumatoid - drug therapy</topic><topic>Empyema, Pleural - immunology</topic><topic>Eosinophilia - drug therapy</topic><topic>Eosinophilia - immunology</topic><topic>Humans</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Middle Aged</topic><topic>Pediatrics</topic><topic>Pleural Effusion - drug therapy</topic><topic>Pleural Effusion - etiology</topic><topic>Pleural Effusion - pathology</topic><topic>Rheumatoid arthritis</topic><topic>Steroids - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Avnon, L Sølling</creatorcontrib><creatorcontrib>Abu-Shakra, M</creatorcontrib><creatorcontrib>Flusser, D</creatorcontrib><creatorcontrib>Heimer, D</creatorcontrib><creatorcontrib>Sion-Vardy, N</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Rheumatology international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Avnon, L Sølling</au><au>Abu-Shakra, M</au><au>Flusser, D</au><au>Heimer, D</au><au>Sion-Vardy, N</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pleural effusion associated with rheumatoid arthritis: what cell predominance to anticipate?</atitle><jtitle>Rheumatology international</jtitle><addtitle>Rheumatol Int</addtitle><date>2007-08</date><risdate>2007</risdate><volume>27</volume><issue>10</issue><spage>919</spage><epage>925</epage><pages>919-925</pages><issn>0172-8172</issn><eissn>1437-160X</eissn><abstract>Pleural involvement is the most frequent manifestation of rheumatoid arthritis (RA) in the chest. We report here two patients who presented with large exudative pleural effusions and subsequently developed sero-positive RA. In both cases, the differential cell count of the pleural effusion suggested empyema. A literature review identified that RA-associated pleural effusion afflicts more men than women and 95% of the patients have high titers of rheumatoid factor (RF). In 46% of cases, RA-associated pleural effusion is diagnosed in close temporal relationship with the diagnosis of RA. The effusion is an exudate and is characterized by low pH and glucose level, and high lactic dehydrogenase (LDH) and cell count. At diagnosis there is a tendency for predominant neutrophils to occur consistent with an empyema and 7-11 days later, the cells in the pleural effusion are replaced by lymphocytes. Pleural effusion with predominant eosinophilia is rare. RA patients with acidic effusion and low glucose content with neutrophils predominance should be treated with thoracic drainage and antibiotics until an infection is ruled out. The histo-pathologic findings in pleural fluid of tadpole cells and multinucleated giant cells and the replacement of the mesothelial cells on the parietal pleural surface with a palisade of macrophage derived cells are described as pathogonomic for RA. Treatment with systemic steroids and intra-pleural steroids are effective in most cases.</abstract><cop>Germany</cop><pub>Springer Nature B.V</pub><pmid>17294192</pmid><doi>10.1007/s00296-007-0322-9</doi><tpages>7</tpages></addata></record> |
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subjects | Aged Arthritis, Rheumatoid - complications Arthritis, Rheumatoid - diagnosis Arthritis, Rheumatoid - drug therapy Empyema, Pleural - immunology Eosinophilia - drug therapy Eosinophilia - immunology Humans Male Medical diagnosis Middle Aged Pediatrics Pleural Effusion - drug therapy Pleural Effusion - etiology Pleural Effusion - pathology Rheumatoid arthritis Steroids - therapeutic use |
title | Pleural effusion associated with rheumatoid arthritis: what cell predominance to anticipate? |
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