What is the clinical evidence from this study?

Study design: Case Report. Population: Rheumatoid arthritis with pleural and pericardial effusions (n=1). Intervention: Methotrexate. Primary outcome: Etiology and resolution of effusions.

What question did this study set out to answer?

To examine the diagnostic challenge of differentiating systemic rheumatoid arthritis complications from drug-induced toxicity and opportunistic infections during immunosuppressive therapy.

December 1, 2020The Permanente JournalOpen Access

Concomitant Large Loculated Pleural and Pericardial Effusions in a Patient with Rheumatoid Arthritis on Methotrexate

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Key result

A 52-year-old man with rheumatoid arthritis on methotrexate developed large pleural and pericardial effusions that were determined to be secondary to his autoimmune disease rather than drug toxicity.

Why the study?

Differentiating pleuropulmonary and pericardial complications of rheumatoid arthritis from side effects of immunosuppressive therapy presents significant diagnostic challenges.

Population

A 52-year-old man with RA on long-term methotrexate and corticosteroid therapy

Design

Case report

Authors

NWNakiya Whitfield AKAnne Krasniak HNHien NguyenKaiser Permanente

Discussion

Member takes

Implication

Alerts clinicians to RA effusion diagnostic pitfalls on therapy; leaves open abatacept's causal role.

Key Points

To examine the diagnostic challenge of differentiating systemic rheumatoid arthritis complications from drug-induced toxicity and opportunistic infections during immunosuppressive therapy.
Evaluated a 52-year-old male with rheumatoid arthritis on long-term methotrexate and corticosteroids presenting with severe acute respiratory symptoms.
Employed the Naranjo adverse drug reaction probability score alongside chest radiography and video-assisted thoracoscopic surgery to guide management.
Chest radiography and surgical exploration identified a large loculated pleural effusion concurrent with pneumonia, requiring chest tube drainage, intravenous methylprednisolone, and antibiotics.
Achieved clinical stabilization by initiating the T-cell co-stimulation modulator abatacept as adjunctive immunosuppressive therapy alongside existing medications.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

A 52-year-old man with rheumatoid arthritis on long-term methotrexate who presented with large loculated pleural and pericardial effusions.

Exposure

Intravenous methylprednisolone, antibiotics, video-assisted thoracoscopic procedure, chest tubes, and abatacept.

This case highlights the diagnostic challenges of differentiating pleuropulmonary and pericardial complications of rheumatoid arthritis from side effects of immunosuppressive therapy.

Limitations

Single case report limits generalizability
Inherent difficulty in definitively distinguishing between rheumatoid pleuritis and methotrexate-induced pleuropulmonary toxicity

Cite This Study

Whitfield et al. (2020) conducted a case report in Rheumatoid arthritis with pleural and pericardial effusions (n=1). Methotrexate was evaluated on Etiology and resolution of effusions. A 52-year-old man with rheumatoid arthritis on methotrexate developed large pleural and pericardial effusions that were determined to be secondary to his autoimmune disease rather than drug toxicity.

synapsesocial.com/papers/6a9fc592d15c5dee7bbab828 https://doi.org/10.7812/tpp/19.239

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Concomitant Large Loculated Pleural and Pericardial Effusions in a Patient with Rheumatoid Arthritis on Methotrexate

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

Concomitant Large Loculated Pleural and Pericardial Effusions in a Patient with Rheumatoid Arthritis on Methotrexate

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider