Treatment of refractory rheumatoid pleural effusion with abatacept

BMJ Case Rep. 2018 Mar 28:2018:bcr2017224034. doi: 10.1136/bcr-2017-224034.


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.

Keywords: biological agents; rheumatoid arthritis.

Publication types

  • Case Reports

MeSH terms

  • Abatacept / therapeutic use*
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / complications*
  • Humans
  • Male
  • Middle Aged
  • Pleural Effusion / drug therapy*
  • Pleural Effusion / etiology*
  • Tomography, X-Ray Computed / methods
  • Treatment Outcome


  • Antirheumatic Agents
  • Abatacept