Ask an Expert: Does Having Pleurisy From RA Mean There Could be Other Problems?

Arthritis and Rheumatism

Does Having Pleurisy From RA Mean There Could be Other Problems?
02/20/2008

Question:

I have seronegetive Rheumatoid Arthritis but mine seems to be far from mild. I was just told by my doctor that I have pleurisy caused by my RA. I was told that lungs being affect by RA is rare and even more rare with seronegetive. Does RA eventualy get worse despite treatment? Now that I have pleurisy, does that mean that I could have other problems with my RA besides my joints?

Answer:

The hallmark pathology of Rheumatoid Arthritis (RA) is joint inflammation. However, RA is a systemic disease and certainly can have associated extra-articular features, one of which is respiratory manifestations. Inflammation of the lung lining is called pleuritis which may lead to pain with deep inspiration, commonly referred to as pleurisy. Symptoms of pleurisy, if related to the underlying RA, do not necessarily demand treatment as the episodes may be episodic and resolve without treatment. Occasionally, fluid within the lung lining (pleural effusion) may be found in individuals with RA. Sometimes these fluid collections do not produce any symptoms and are found incidentally on a chest x-ray. Treatment for pleuritis or pleural effusions may be required if they produce chronic symptoms or if they cause respiratory compromise such as shortness of breath.
Final thought: Pleurisy and pleural effusions may affect any individual with RA, even if they have a normal rheumatoid factor blood test. Rheumatoid nodules and lung fibrosis are much less likely to occur in the setting of a normal rheumatoid factor.

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Response by:

Raymond Hong, MD, MBA, FACR
Formerly, Assistant Professor of Medicine
School of Medicine
Case Western Reserve University