Jacobsen S
Medicinsk afdeling, Amtssygehuset i Nåkskov.
Ugeskr Laeger. 1993 Mar 15;155(11):808-9.
A case of pleuropulmonary manifestations of rheumatoid arthritis (RA) in the form of persistent pleuritis and effusion in a 58 year old male patient with known RA is presented. The well-known pleuropulmonary complications of RA pleurisy, interstitial fibrosis, effusion, rheumatoid nodules and Caplan's syndrome can occur in sero-negative patients without primary articular symptoms and therefore pose difficult problems in differential diagnosis. These problems can be partially overcome by thoracoscopic visualization of the often characteristic changes of the parietal pleura: hyperemia, vasculitis and rheumatoid nodules and histochemical examination of the pleural liquid will show low glucose concentration, high protein concentration, elevated lactate-dehydrogenase concentration, acid pH and a characteristic cytomorphology with mononuclear and neutrophil leucocytes in typical cases. The pleuropulmonary manifestations can sometimes be successfully treated with a combination of NSAIDs and methotrexate.
本文报告了一例58岁男性类风湿关节炎（RA）患者，以持续性胸膜炎和胸腔积液为表现形式的胸膜肺部表现。RA常见的胸膜肺部并发症，如胸膜炎、间质性纤维化、胸腔积液、类风湿结节和卡普兰综合征，可发生在无原发性关节症状的血清阴性患者中，因此在鉴别诊断中存在难题。通过胸腔镜观察壁层胸膜常见的特征性改变（充血、血管炎和类风湿结节），以及对胸腔积液进行组织化学检查，可部分解决这些问题：典型病例中胸腔积液葡萄糖浓度低、蛋白质浓度高、乳酸脱氢酶浓度升高、pH值呈酸性，且具有单核细胞和中性粒细胞的特征性细胞形态。胸膜肺部表现有时可通过非甾体抗炎药（NSAIDs）和甲氨蝶呤联合治疗成功治愈。
