Regarding Rheumatoid Pleural Effusion...

A 43-year-old man with a past history of hypothyroidism presents with a 3-month history of
pain and stiffness in the joints of his hands and feet. He also gives a history of dyspnoea, which
started 6 weeks ago. Examination shows swollen hand joints and signs of a right pleural effusion.
A diagnosis of RA is made. Which one of the following is characteristic of a rheumatoid pleural
effusion?

A. It is a transudate
B. It has a low glucose level
C. Long-standing rheumatoid effusions have low cholesterol levels
D. It has a high Ph
E. It should be treated by decortication

Answer:
B--It has a low glucose level

Rheumatoid Pleural Effusion
Up to 5% of patients with RA develop pleural effusions at some stage. Pleural effusions are more
common in men. These effusions are exudates and typically have a low pH (< 7.2), a high lactic
acid dehydrogenase (LDH) level and a low glucose level.
RA is unlikely to be the cause of an effusion if the glucose level in the fluid is over 1.6 mmol/l. Large amounts of cholesterol can accumulate in long-standing rheumatoid pleural effusions.

Treatment: Patients should be treated initially with nonsteroidal anti-inflammatory drugs (NSAIDs). Decortication should be considered in patients with thickened pleura who are symptomatic with dyspnoea.