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| ==Overview== | | ==[[Rheumatoid pleuritis overview|Overview]]== |
| '''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)
| | ==[[Rheumatoid pleuritis pathophysiology |Pathophysiology]]== |
| | | ==[[Rheumatoid pleuritis differential diagnosis|Differentiating Rheumatoid pleuritis from other Diseases]]== |
| ==Histopathology== | | ==[[Rheumatoid pleuritis epidemiology and demographics|Epidemiology and Demographics]]== |
| Light microscopy reveals replacement of normal cells lining the pleura ([[Mesothelium|mesothelial cells]]) by a layer of pseudostratified epithelioid cells, [[multinucleated]] giant [[macrophage]]s, and [[necrotic]] material (Mandl et al, 1969; Lillington et al 1971)
| | ==[[Rheumatoid pleuritis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==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.
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| ==Diagnosis== | | ==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.
| | [[Rheumatoid pleuritis history and symptoms|History and Symptoms]] | [[Rheumatoid pleuritis physical examination|Physical Examination]] | [[Rheumatoid pleuritis laboratory findings|Laboratory Findings]] | [[Rheumatoid pleuritis chest x ray|Chest X Ray]] | [[Rheumatoid pleuritis CT|CT]] | [[Rheumatoid pleuritis other diagnostic studies|Other Diagnostic Studies]] |
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| ==Treatment== | | ==Treatment== |
| Steroids are the mainstay of treatment for rheumatoid arthritis, and have been shown to improve rheumatoid pleuritis.
| | [[Rheumatoid pleuritis medical therapy|Medical Therapy]] | [[Rheumatoid pleuritis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Rheumatoid pleuritis future or investigational therapies|Future or Investigational Therapies]] |
| | | ==Case Studies== |
| ==References==
| | :[[Rheumatoid pleuritis case study one|Case #1]] |
| * {{cite journal | author=Champion GD, Robertson MR, Robinson RG | title=Rheumatoid pleurisy and pericarditis | journal=Ann Rheum Dis | year=1968 | pages=521-30 | volume=27 | issue=6 | id=PMID 4178130}}
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| * {{cite journal | author=Chou CW, Chang SC | title=Pleuritis as a presenting manifestation of rheumatoid arthritis: diagnostic clues in pleural fluid cytology | journal=Am J Med Sci | year=2002 | pages=158-61 | volume=323 | issue=3 | id=PMID 11908862}}
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| * {{cite journal | author=Engel U, Aru A, Francis D | title=Rheumatoid pleurisy. Specificity of cytological findings | journal=Acta Pathol Microbiol Immunol Scand [A] | year=1986 | pages=53-6 | volume=94 | issue=1 | id=PMID 3962679}}
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| * {{cite journal | author=Geisinger KR, Vance RP, Prater T, Semble E, Pisko EJ | title=Rheumatoid pleural effusion. A transmission and scanning electron microscopic evaluation | journal=Acta Cytol | year=1985 | pages=239-47 | volume=29 | issue=3 | id=PMID 3890439}}
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| * {{cite journal | author=Graham WR | title=Rheumatoid pleuritis | journal=South Med J | year=1990 | pages=973-5 | volume=83 | issue=8 | id=PMID 2200144}}
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| * {{cite journal | author=Lillington GA, Carr DT, Mayne JG | title=Rheumatoid pleurisy with effusion | journal=Arch Intern Med | year=1971 | pages=764-8 | volume=128 | issue=5 | id=PMID 5119224}}
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| * {{cite journal | author=Mandl MA, Watson JI, Henderson JA, Wang N | title=Pleural fluid in rheumatoid pleuritis. Patient summary with histopathologic studies | journal=Arch Intern Med | year=1969 | pages=373-6 | volume=124 | issue=3 | id=PMID 4896636}}
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| * {{cite journal | author=Montes S, Guarda LA | title=Cytology of pleural effusions in rheumatoid arthritis | journal=Diagn Cytopathol | year=1988 | pages=71-3 | volume=4 | issue=1 | id=PMID 3378489}}
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| * {{cite journal | author=Naylor B | title=The pathognomonic cytologic picture of rheumatoid pleuritis. The 1989 Maurice Goldblatt Cytology award lecture | journal=Acta Cytol | year=1990 | pages=465-73 | volume=34 | issue=4 | id=PMID 2197838}}
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| * {{cite journal | author=Nosanchuk JS, Naylor B | title=A unique cytologic picture in pleural fluid from patients with rheumatoid arthritis | journal=Am J Clin Pathol | year=1968 | pages=330-5 | volume=50 | issue=3 | id=PMID 5676332}}
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| * {{cite journal | author=Shinto R, Prete P | title=Characteristic cytology in rheumatoid pleural effusion | journal=Am J Med | year=1988 | pages=587-9 | volume=85 | issue=4 | id=PMID 3177420}}
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| * {{cite journal | author=Walker WC, Wright V | title=Rheumatoid pleuritis | journal=Ann Rheum Dis | year=1967 | pages=467-74 | volume=26 | issue=6 | id=PMID 6066230}}
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| [[Category:Pulmonology]] | | [[Category:Pulmonology]] |