Skip to main content
PMC home page
Thorax logoLink to Thorax
. 1982 May;37(5):354–361. doi: 10.1136/thx.37.5.354

Chemical and immunological features of pleural effusions: comparison between rheumatoid arthritis and other diseases.

T Pettersson, M Klockars, P E Hellström
PMCID: PMC459316  PMID: 6981226

Abstract

The value of determination of pleural fluid glucose, pH, lactic dehydrogenase, IgG, IgA, IgM, C3, C4, anti-IgG antibody, and hydroxyproline in distinguishing between pleural effusions caused by rheumatoid arthritis (RA) and those resulting from other diseases was studied. The series comprised seven patients with RA and 115 patients with other diseases including systemic lupus erythematosus, tuberculosis, malignant disease, empyema, pneumonia, congestive heart failure, and nonspecific pleural effusion. The low glucose concentration, the low pH and the low C4 level in rheumatoid pleural effusion were the most valuable diagnostic findings. The presence of anti-IgG antibody in pleural fluid was not specific for RA. The concentration of hydroxyproline in pleural fluid and the pleural fluid-to-plasma hydroxyproline ratio were significantly higher in RA than in tuberculosis and malignant disease. The results support the view that local metabolic and immunological phenomena as well as a high turnover of collagen occur in the pleural cavity in RA.

Full text

PDF
355

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ABRAMS L. D. A pleural-biopsy punch. Lancet. 1958 Jan 4;1(7010):30–31. doi: 10.1016/s0140-6736(58)92521-2. [DOI] [PubMed] [Google Scholar]
  2. Berger H. W., Seckler S. G. Pleural and pericardial effusions in rheumatoid disease. Ann Intern Med. 1966 Jun;64(6):1291–1297. doi: 10.7326/0003-4819-64-6-1291. [DOI] [PubMed] [Google Scholar]
  3. CARR D. T., POWER M. H. Pleural fluid glucose with special reference to its concentration in rheumatoid pleurisy with effusion. Dis Chest. 1960 Mar;37:321–324. doi: 10.1378/chest.37.3.321. [DOI] [PubMed] [Google Scholar]
  4. Carr D. T., Lillington G. A., Mayne J. G. Pleural-fluid glucose in systemic lupus erythematosus. Mayo Clin Proc. 1970 Jun;45(6):409–412. [PubMed] [Google Scholar]
  5. Dayer J. M., Graham R., Russell G., Krane S. M. Collagenase production by rheumatoid synovial cells: stimulation by a human lymphocyte factor. Science. 1977 Jan 14;195(4274):181–183. doi: 10.1126/science.188134. [DOI] [PubMed] [Google Scholar]
  6. Dodson W. H., Hollingsworth J. W. Pleural effusion in rheumatoid arthritis. Impaired transport of glucose. N Engl J Med. 1966 Dec 15;275(24):1337–1342. doi: 10.1056/NEJM196612152752404. [DOI] [PubMed] [Google Scholar]
  7. FARR R. S. A quantitative immunochemical measure of the primary interaction between I BSA and antibody. J Infect Dis. 1958 Nov-Dec;103(3):239–262. doi: 10.1093/infdis/103.3.239. [DOI] [PubMed] [Google Scholar]
  8. Falchuk K. H., Goetzl E. J., Kulka J. P. Respiratory gases of synovial fluids. An approach to synovial tissue circulatory-metabolic imbalance in rheumatoid arthritis. Am J Med. 1970 Aug;49(2):223–231. doi: 10.1016/s0002-9343(70)80078-x. [DOI] [PubMed] [Google Scholar]
  9. Faurschou P., Faarup P. Granulocytes containing cytoplasmic inclusions in human tuberculous pleuritis. Scand J Respir Dis. 1973;54(6):341–346. [PubMed] [Google Scholar]
  10. Faurschou P., Faarup P. Pleural granulocytes with cytoplasmic inclusions from patients with malignant lung tumours and mesothelioma. Eur J Respir Dis. 1980 Jun;61(3):151–155. [PubMed] [Google Scholar]
  11. Glovsky M. M., Louie J. S., Pitts W. H., Jr, Alenty A. Reduction of pleural fluid complement activity in patients with systemic lupus erythematosus and rheumatoid arthritis. Clin Immunol Immunopathol. 1976 Jul;6(1):31–41. doi: 10.1016/0090-1229(76)90057-x. [DOI] [PubMed] [Google Scholar]
  12. Halla J. T., Schrohenloher R. E., Volanakis J. E. Immune complexes and other laboratory features of pleural effusions: a comparison of rheumatoid arthritis, systemic lupus erythematosus, and other diseases. Ann Intern Med. 1980 Jun;92(6):748–752. doi: 10.7326/0003-4819-92-6-748. [DOI] [PubMed] [Google Scholar]
  13. Halla J. T., Schrohenloher R. E., Volanakis J. E. Observations on some properties of immune complexes in a rheumatoid arthritis patient presenting with simultaneous synovitis and pleurisy. Arthritis Rheum. 1980 Nov;23(11):1318–1320. doi: 10.1002/art.1780231116. [DOI] [PubMed] [Google Scholar]
  14. Hunder G. G., McDuffie F. C., Hepper N. G. Pleural fluid complement in systemic lupus erythematosus and rheumatoid arthritis. Ann Intern Med. 1972 Mar;76(3):357–363. doi: 10.7326/0003-4819-76-3-357. [DOI] [PubMed] [Google Scholar]
  15. Hunder G. G., McDuffie F. C., Huston K. A., Elveback L. R., Hepper N. G. Pleural fluid complement, complement conversion, and immune complexes in immunologic and nonimmunologic diseases. J Lab Clin Med. 1977 Dec;90(6):971–980. [PubMed] [Google Scholar]
  16. Kivirikko K. I., Laitinen O., Prockop D. J. Modifications of a specific assay for hydroxyproline in urine. Anal Biochem. 1967 May;19(2):249–255. doi: 10.1016/0003-2697(67)90160-1. [DOI] [PubMed] [Google Scholar]
  17. LEROY E. C., SJOERDSMA A. CLINICAL SIGNIFICANCE OF A HYDROXYPROLINE-CONTAINING PROTEIN IN HUMAN PLASMA. J Clin Invest. 1965 Jun;44:914–919. doi: 10.1172/JCI105208. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Levine H., Szanto M., Grieble H. G., Bach G. L., Anderson T. O. Rheumatoid factor in nonrheumatoid pleural effusions. Ann Intern Med. 1968 Sep;69(3):487–492. doi: 10.7326/0003-4819-69-3-487. [DOI] [PubMed] [Google Scholar]
  19. Light R. W., Macgregor M. I., Luchsinger P. C., Ball W. C., Jr Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med. 1972 Oct;77(4):507–513. doi: 10.7326/0003-4819-77-4-507. [DOI] [PubMed] [Google Scholar]
  20. Lillington G. A., Carr D. T., Mayne J. G. Rheumatoid pleurisy with effusion. Arch Intern Med. 1971 Nov;128(5):764–768. [PubMed] [Google Scholar]
  21. Mancini G., Carbonara A. O., Heremans J. F. Immunochemical quantitation of antigens by single radial immunodiffusion. Immunochemistry. 1965 Sep;2(3):235–254. doi: 10.1016/0019-2791(65)90004-2. [DOI] [PubMed] [Google Scholar]
  22. Mandl M. A., Watson J. I., Henderson J. A., Wang N. Pleural fluid in rheumatoid pleuritis. Patient summary with histopathologic studies. Arch Intern Med. 1969 Sep;124(3):373–376. [PubMed] [Google Scholar]
  23. Manicourt D., Brauman H., Orloff S. Synovial fluid beta 2 microglobulin and hydroxyproline fractions in rheumatoid arthritis and nonautoimmune arthropathies. Ann Rheum Dis. 1980 Jun;39(3):207–216. doi: 10.1136/ard.39.3.207. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Pettersson T., Klockars M., Hellström P. E., Riska H., Wangel A. T and B lymphocytes in pleural effusions. Chest. 1978 Jan;73(1):49–51. doi: 10.1378/chest.73.1.49. [DOI] [PubMed] [Google Scholar]
  25. Pettersson T., Riska H. Diagnostic value of total and differential leukocyte counts in pleural effusions. Acta Med Scand. 1981;210(1-2):129–135. doi: 10.1111/j.0954-6820.1981.tb09788.x. [DOI] [PubMed] [Google Scholar]
  26. Potts D. E., Willcox M. A., Good J. T., Jr, Taryle D. A., Sahn S. A. The acidosis of low-glucose pleural effusions. Am Rev Respir Dis. 1978 Apr;117(4):665–671. doi: 10.1164/arrd.1978.117.4.665. [DOI] [PubMed] [Google Scholar]
  27. Sahn S. A., Kaplan R. L., Maulitz R. M., Good J. T., Jr Rheumatoid pleurisy. observations on the development of low pleural fluid pH and glucose level. Arch Intern Med. 1980 Sep;140(9):1237–1238. doi: 10.1001/archinte.140.9.1237. [DOI] [PubMed] [Google Scholar]
  28. Shallenberger D. W., Daniel T. M. Quantitative determination of several pleural fluid proteins. Am Rev Respir Dis. 1972 Jul;106(1):121–122. doi: 10.1164/arrd.1972.106.1.121. [DOI] [PubMed] [Google Scholar]
  29. Sliwinski A. J., Zvaifler N. J. In vivo synthesis of IgG by rheumatoid synovium. J Lab Clin Med. 1970 Aug;76(2):304–310. [PubMed] [Google Scholar]
  30. Stengel B. F., Watson R. R., Darling R. J. Pulmonary rheumatoid nodule with cavitation and chronic lipid effusion. JAMA. 1966 Dec 19;198(12):1263–1266. [PubMed] [Google Scholar]
  31. Taryle D. A., Good J. T., Jr, Sahn S. A. Acid generation by pleural fluid: possible role in the determination of pleural fluid pH. J Lab Clin Med. 1979 Jun;93(6):1041–1046. [PubMed] [Google Scholar]
  32. Telvi L., Jaubert F., Eyquem A., Andreux J. P., Labrousse F., Chrétien J. Study of immunoglobulins in pleura and pleural effusions. Thorax. 1979 Jun;34(3):389–392. doi: 10.1136/thx.34.3.389. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Uitto J., Lindy S., Turto H., Vainio K. Collagen biosynthesis in rheumatoid synovial tissue. J Lab Clin Med. 1972 Jun;79(6):960–971. [PubMed] [Google Scholar]
  34. Walker W. C., Wright V. Rheumatoid pleuritis. Ann Rheum Dis. 1967 Nov;26(6):467–474. doi: 10.1136/ard.26.6.467. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. ZINNEMAN H. H., JOHNSON J. J., LYON R. H. Proteins and mucoproteins in pleural effusions. Am Rev Tuberc. 1957 Aug;76(2):247–255. doi: 10.1164/artpd.1957.76.2.247. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES