Pleural and Pericardial Effusions in Rheumatoid Disease

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Abstract
Two cases with pleural effusions due to rheumatoid disease were observed; one also had a pericardial effusion. Both patients were middle aged males with typical rheumatoid arthritis and subcutaneous nodules who developed pleurisy several years following the onset of their arthritis. In each case the pleurisy could not be attributed to another disease. The pleural fluid in both patients contained from less than 2 mg/100 ml to 12 mg/100 ml of sugar, a lactic acid dehydrogenase more than 3000 units, and positive latex fixation titers. Cells morphologically resembling R. A. [rheumatoid arthritis] cells were also noted in the pleural fluid. These cells have recently been reported in the synovial fluid of patients with rheumatoid arthritis. The histology of the needle pleural biopsy in case 1 resembled a rheumatoid nodule while that in case 2 showed chronic pleuritis. The pericardial fluid in case 2 contained less than 2 mg/100 ml of sugar, had a positive latex fixation titer, and also demonstrated R. A. cells. It is suggested that these observations may provide more objective criteria than presently available for diagnosing rheumatoid pleurisy and pericarditis.

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