Rheumatoid Arthritis with Pleural Effusion Includes a Subgroup with Autoimmune Features and HLA-B8, Dw3 Association

Abstract

Twenty-eight patients with rheumatoid pleural effusion were investigated to examine the frequency of HLA antigens as compared with 56 rheumatoid arthritis (RA) patients without this intrathoracic manifestation of RA and with 283 healthy controls. HLA-B8 was strongly associated with the presence of pleural effusion (PE) in RA patients. A high prevalence (71%) of B8/Dw3 was found among male RA patients of the PE group in whom the joint disease had begun at an age over 50 years and who also had besides pleuritis other intrathoracic manifestations of RA associated with high rheumatoid factor titres and low complement (C4) levels in sera. Actually, the HLA-B8 association was not seen in the rest of the PE group. The finding may be related to the heterogeneity of RA, a male subgroup of the disease being characterized by multiple intrathoracic manifestations and genetically associated with the large group of autoimmune disorders, such as SLE, characterized by high prevalences of HLA-B8 and D(R)3.

Cardiovascular Mortality in Patients with Rheumatoid Arthritis

“…This could be explained on the basis of lower death rate among women than among men, because also women with RA showed a trend towards higher mortality from cardiac causes than women without RA. Rheumatoid lung disease is more com mon in men than in women, and recently a subgroup of male RA patients with a high frequency of HLA B 8, Dw 3 and intrathoracic manifestations including pleural effu sion, diffuse interstitial lung disease, pericar ditis and conduction defects has been de scribed [25]. Therefore, it is not excluded that male patients with RA would be more prone to cardiac diseases than female pa tients with RA.…”

The lung in rheumatoid arthritis

“…Usually there is no correlation between the appearance of pleural effusion and joint disease activity [149]; although in some patients, worsening arthritis was reported with the appearance of pleural effusion [150]. A genetic predisposition to rheumatoid pleurisy has also been reported, with a high prevalence of HLA-B8 and Dw3 associated with rheumatoid pleural effusion [151]. Most patients with rheumatoid pleural effusion are asymptomatic and have small amounts of pleural effusion [139][140][141].…”

Pleural Involvement in Systemic Autoimmune Disorders

“…Middle-aged men with high titers of rheumatoid factor (RF) are mainly affected [7]. A genetic predisposition of rheumatoid pleurisy has also been reported, with a high prevalence of HLA-B8 and Dw3 associated with rheumatoid pleural effusion [8, 9]. …”

“…Typical rheumatoid nodules are an occasional finding. These findings are pathognomonic for rheumatoid pleuritis, but histological appearances are nonspecific in many cases and needle biopsy specimens generally show nonspecific evidence of chronic pleuritis [8, 9]. …”