Pleurisy with effusion in rheumatoid arthritis, with reference to the low concentration of glucose in pleural fluid

Pleural effusion: diagnosis, treatment, and management

A pleural effusion is an excessive accumulation of fluid in the pleural space. It can pose a diagnostic dilemma to the treating physician because it may be related to disorders of the lung or pleura, or to a systemic disorder. Patients most commonly present with dyspnea, initially on exertion, predominantly dry cough, and pleuritic chest pain. To treat pleural effusion appropriately, it is important to determine its etiology. However, the etiology of pleural effusion remains unclear in nearly 20% of cases. Thoracocentesis should be performed for new and unexplained pleural effusions. Laboratory testing helps to distinguish pleural fluid transudate from an exudate. The diagnostic evaluation of pleural effusion includes chemical and microbiological studies, as well as cytological analysis, which can provide further information about the etiology of the disease process. Immunohistochemistry provides increased diagnostic accuracy. Transudative effusions are usually managed by treating the underlying medical disorder. However, a large, refractory pleural effusion, whether a transudate or exudate, must be drained to provide symptomatic relief. Management of exudative effusion depends on the underlying etiology of the effusion. Malignant effusions are usually drained to palliate symptoms and may require pleurodesis to prevent recurrence. Pleural biopsy is recommended for evaluation and exclusion of various etiologies, such as tuberculosis or malignant disease. Percutaneous closed pleural biopsy is easiest to perform, the least expensive, with minimal complications, and should be used routinely. Empyemas need to be treated with appropriate antibiotics and intercostal drainage. Surgery may be needed in selected cases where drainage procedure fails to produce improvement or to restore lung function and for closure of bronchopleural fistula.

Cardiac tamponade in juvenile chronic arthritis: report of two cases and review of publications

Two cases of systemic juvenile chronic arthritis, complicated by cardiac tamponade and eight previously reported cases are described. The clinical features and radiological, electrocardiographic, and echocardiographic findings were similar for all cases. One patient in this series was treated with corticosteroids and underwent pericardiectomy, dying of sepsis 30 days after surgery. The other patient was also treated with corticosteroids, underwent pericardiocentesis and developed fatal ventricular tachycardia. Of the 10 cases, only six were successfully treated. Early diagnosis and appropriate treatment are essential for a favourable outcome.

Thoracoscopic, histological, and clinical findings in nine case of rheumatoid pleural effusion

A characteristic thoracoscopic picture of a granular parietal pleural surface was found in nine patients with rheumatoid pleurisy. Characteristic changes could be identified histopathologically in material obtained by biopsy. The rheumatoid pleural effusion resolved within an average of 14 months and no serious complications developed after the pleurisy. It is concluded that in rheumatoid pleural effusion a positive diagnosis can be made by thoracoscopy, preferably supported by the identification of microscopic structural changes in the parietal pleura.

Juvenile rheumatoid arthritis with cardiac tamponade

A 4-year-old girl with seronegative systemic juvenile rheumatoid arthritis developed acute cardiac tamponade. Pericardiocentesis and systemic corticosteroids resulted in complete recovery of the pericardial involvement. This was followed by complete remission of rheumatoid disease.

Episcleritis and scleritis. A study of their clinical manifestations and association with rheumatoid arthritis

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Empyema in rheumatoid arthritis

Case notes of the last 67 patients to present at the Brompton Hospital with nontuberculous empyemas, and without malignant disease, have been examined. Three cases of empyema in association with rheumatoid arthritis (RA) were found, and these cases are reported. Previous literature concerning this association is reviewed. It is concluded that two types of empyema may occur in patients with RA. Some develop in association with nodular pleuropulmonary disease and the formation of pyopneumothoraces; in other cases large, recurrent, primary empyemas build up in the presence of active rheumatoid disease alone. As with rheumatoid pleural effusions, middle-aged men seem to be particularly susceptible.

Pericarditis associated with rheumatoid arthritis

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