ArticleCureus2026
From Dyspnea to Diagnosis: Neutrophilic Pleural Effusion With Elevated Adenosine Deaminase As the First Clue to New-Onset Rheumatoid Arthritis.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
5 authors.
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Abstract
Rheumatoid arthritis (RA) rarely announces itself with a pleural effusion, yet when it does, the biochemical and pleural fluid profile often leads to a suspicion of infectious etiology at first. We describe a 44‑year‑old woman whose initial manifestation of seropositive RA was a large, unilateral, neutrophil‑rich, adenosine‑deaminase (ADA)-positive pleural effusion. The case draws attention to a diagnostic pitfall: elevated pleural fluid ADA-although classically associated with tuberculous pleuritis-can also occur in rheumatoid pleuritis, highlighting that ADA levels must be interpreted in the full clinical context and should not, by themselves, prompt initiation of anti-tuberculous therapy. By combining serial fluid analysis with targeted serology, we avoided unnecessary antimycobacterial therapy, initiated immunosuppression early, and achieved complete radiographic resolution. The report emphasizes the need to identify extra-articular conditions (especially pleural involvement) as potential early indicators of RA development.
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