类风湿关节炎胸膜受累的临床特点分析

目的提高对于类风湿关节炎(RA)胸膜受累的认识。方法回顾分析RA住院患者胸膜受累的临床特点。结果 248例RA患者中29例胸膜受累,5例胸膜增厚,24例出现胸腔积液;其中18例少量胸腔积液,无症状,无特殊治疗;另外6例中等量胸腔积液,有呼吸困难的症状,予胸腔穿刺引流,胸腔积液为渗出液;4例RA相关,激素治疗后胸腔积液吸收;1例继发结核性胸膜炎,抗结核后好转;1例肺炎旁胸腔积液,抗感染后好转。结论 RA患者可出现胸腔积液或胸膜增厚,一般无症状,无需特殊处理。但胸腔积液明显时,需要排除细菌、结核感染及肿瘤等,胸腔穿刺引流和激素等治疗可缓解症状,继发细菌和结核等感染需要相应的抗感染治疗。

Pleural Involvement in Rheumatoid Arthritis

Objective To improve understanding of pleural involvement in rheumatoid arthritis(RA).Methods A retrospective analysis was performed in patients with pleural involvement.Results The 29 cases presented with pleural disease in 248 Rheumatoid arthritis(RA) patients,5 of them with pleural thickening,24 patients with pleural effusion(PE).18 patients with PE were small and asymptomatic and did not require intervention.Middle amounts of pleural fluid compromise respiratory function and require aspiration to allow underlying lung expansion in other 6 patients.The fluid was exudative.Rheumatoid pleural effusion was considered in 4 patients,responding to corticosteroid.Tuberculous pleurisy was conformed in 1 patient.Another patient was diagnosed as parapneumonic effusion.Both received antibiotic therapy with a good response.Conclusion Pleural effusion or pleural thickening is a common feature of RA.In most cases,PE is small and asymptomatic,and there is no need for intervention.Middle amounts of pleural fluid compromise respiratory function and require aspiration and corticosteroid.Exclusion of other causes of exudates is important,such as bacterial infection,tuberculosis and malignancy.Secondary infection should receive antibiotic therapy instead of corticosteroid.