Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive dyspnea, non-productive cough, and pleuritic chest pain in the setting of long-standing seropositive rheumatoid arthritis. Symptoms are associated with constitutional signs including fatigue, low-grade fever, and weight loss. No history of recent trauma, cardiac failure, or infectious exposure.
Clinical Examination Findings
Respiratory exam reveals decreased tactile fremitus, stony dullness to percussion, and absent breath sounds at the affected lung base. Musculoskeletal exam demonstrates active rheumatoid synovitis, including MCP/PIP joint swelling, ulnar deviation, and subcutaneous rheumatoid nodules.
Treatment Protocol
Management includes therapeutic thoracentesis for symptomatic relief and diagnostic analysis (exudative profile: low glucose <30 mg/dL, high LDH, low pH). Optimization of systemic DMARDs (e.g., Methotrexate, TNF-inhibitors) is required. Consider intrapleural corticosteroids or pleurodesis for refractory or recurrent effusions.