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Treatment of refractory rheumatoid pleural effusion with abatacept
  1. Shunichi Fujita,
  2. Tomoyuki Mukai,
  3. Takahiko Akagi,
  4. Yoshitaka Morita
  1. Department of Rheumatology, Kawasaki Medical School, Kurashiki, Japan
  1. Correspondence to Dr Yoshitaka Morita, morita{at}


Rheumatoid pleural effusion is generally responsive to corticosteroids, but refractory cases require consideration of second-line therapy. Here we report the case of a 61-year-old man with rheumatoid arthritis (RA) who developed a large right-sided pleural effusion and was successfully treated with abatacept. Thoracocentesis showed a sterile exudate and an elevated adenosine deaminase level. The methotrexate and etanercept used to treat the RA were withheld initially while he underwent a trial of prednisolone 40 mg/day for the pleural effusion. However, the effusion did not respond to this therapy. Thoracoscopic biopsy of the right pleura revealed fibrotic changes with lymphocyte infiltration mainly composed of CD4+ T cells and B cells but no evidence of malignancy or infection. The patient was started on abatacept and resumed methotrexate. The treatment was effective in our case. Abatacept should be considered as a treatment option in patients with refractory rheumatoid pleural effusion.

  • rheumatoid arthritis
  • biological agents

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  • Contributors SF and YM are involved in conception or design of the work. SF is responsible for acquisition of data. All authors are responsible for analysis and interpretation of data. SF and YM drafted the manuscript or revised.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests All authors received scholarship donations from AbbVie, Actelion, Astellas, Ayumi, Bristol-Myers, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Japan Blood Products Organization, Mitsubishi-Tanabe, MSD, Pfizer, Shionogi, Takeda, Teijin, and UCB.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.