**Core Concept**
Pleural effusion in rheumatoid arthritis (RA) is a type of exudative effusion, which is characterized by the presence of high protein content, low glucose levels, and an elevated lactate dehydrogenase (LDH) level in the pleural fluid. This occurs due to inflammation and fibrosis of the pleura, which is a common feature of RA.

**Why the Correct Answer is Right**
In RA, pleural effusion is often associated with high levels of rheumatoid factor and anti-citrullinated protein antibodies in the pleural fluid. The inflammation of the pleura leads to the accumulation of fluid, which is rich in protein and contains a high number of lymphocytes and neutrophils. The low glucose levels in the pleural fluid are due to the consumption of glucose by the inflammatory cells. The elevated LDH level is a marker of tissue damage and cellular turnover.

**Why Each Wrong Option is Incorrect**
* **Option A:** While pleural effusion in RA can be bilateral, it is not a universal feature of the disease. However, it can be associated with severe disease and a poor prognosis.
* **Option B:** High levels of rheumatoid factor and anti-citrullinated protein antibodies are indeed associated with pleural effusion in RA, making this option incorrect.
* **Option C:** Low glucose levels in the pleural fluid are a characteristic feature of RA-associated pleural effusion, making this option incorrect.

**Clinical Pearl / High-Yield Fact**
The presence of rheumatoid factor and anti-citrullinated protein antibodies in the pleural fluid can be used to diagnose RA-associated pleural effusion. This is a useful diagnostic clue, especially in patients with a known history of RA.

**Correct Answer:** D