A 65 Year Old Man Known Case Of Rheumatoid Arthritis develops A Pleural Effusion...

A 65-yr -old man with severe RA is admitted with a right pleural effusion. He has been
complaining of dyspnoea on exertion for the last three months. He has never smoked and has not
worked for over 20 yrs when he was diagnosed to be suffering from rheumatoid arthritis. Which
of the following is true?
A. Pleural effusions with RA occur in over 50% of pts
B. A glucose level in pleural fluid of < 1.6 mmol/l is characteristic of a rheumatoid pleural effusion
C. Pleural effusions associated with RA have low levels of cholesterol
D. The most appropriate Rx is chemical pleurodesis
E. Bilateral pleural effusions do not occur in RA

Answer:
B) A glucose level in pleural fluid of < 1.6 mmol/l is characteristic of a rheumatoid pleural effusion

Discussion: Some 5% of patients with RA develop pleural effusions. These mainly occur in older male paients with subcutaneous nodules. In 25% of pts it may be bilateral.
These effusions are characterised by :

• low glucose (< 1.6 mmol/l), 
• high LDH (> 700 IU/l), 
• a low pH (< 7.2) and 
• a high rheumatoid factor titre (> 1:320). 
• Another feature is that they may have high cholesterol levels. 

The majority of these effusions resolve spontaneously within three months. Occasionally they may persist and in such patients massive pleural thickening develops. These patients may need decortication if they are symptomatic.