Rheumatoid Pleuritis: Observations in Eight Cases and Suggestions for Making the Diagnosis in Patients without the "Typical Findings"

¹ Pulmonary Disease Service, Fitzsimons General Hospital

Eight patients with rheumatoid disease and associated pleuritis have been described. The majority of cases previously reported have had a nonspecific inflammatory pleural reaction. The possibility of coexisting disease as a cause of pleuritis is difficult to dispel; however, the diagnosis can be suspected by appreciation of the clinical setting. The age and sex of the patient (middle-aged men, primarily), the stage of the disease (flare-ups), the duration of existence of the disease (usually of long duration), high incidence of allergies, and the presence of rheumatoid nodules should receive careful consideration. Many of these criteria are applicable to younger patients. The definitive pathology of the rheumatoid nodule is much less likely to be noted in the lung than in affected joints. However, the presence in pleural fluid of "RA" cells, high lactic dehydrogenase levels, and positive rheumatoid factor, with positive rheumatoid factor test but negative lupus cells in the blood, substantiate the rheumatoid etiology. Circulating eosinophilia may be of additional value in the diagnosis.