Chest Pain Due to Pericardial Effusion as Initial Presenting Feature of Rheumatoid Arthritis: Case Report and Review of the Literature

Movahedian, Malahat; Afzal, Wais; Shoja, Tannaz; Cervellione, Kelly; Nahar, Jebun; Teller, Katerina

doi:10.14740/cr570e

Cited by 9 publications

(7 citation statements)

References 15 publications

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“…Usually, indomethacin is prescribed at the dose of 75–150 mg daily, or ibuprofen at 1600–3200, and aspirin 2–4 g daily to achieve optimal anti-inflammatory activity. 45 CRP levels should be monitored throughout the course of treatment, and NSAIDs/aspirin should be stopped when CRP levels normalize. Corticosteroids are another option for patients with recurrent pericarditis.…”

Section: Cardiac Manifestationsmentioning

confidence: 99%

“…Symptomatic pericarditis is found to have higher mortality in patients with RA. 45 Other pericardial complications seen in newly diagnosed and long-standing RA are cholesterol pericarditis, effusive-constrictive pericarditis, pericardial effusions and cardiac tamponade. RA (or other connective tissue disease) should always be ruled out in patients with pericardial effusion without any probable etiology.…”

Section: Cardiac Manifestationsmentioning

confidence: 99%

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Cardiovascular Manifestations in Rheumatoid Arthritis

Sanghavi

Ingressia

Korem

et al. 2022

Cardiology in Review

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Rheumatoid arthritis (RA) is a systemic inflammatory disorder that characteristically affects the joints. RA has extra-articular manifestations that can impact multiple organ systems including the heart, lungs, eyes, skin, and brain. Cardiovascular involvement is a leading cause of mortality in RA. Cardiovascular manifestations of RA include accelerated atherosclerosis, heart failure, pericarditis, myocarditis, endocarditis, rheumatoid nodules, and amyloidosis. Inflammation is an important mediator of endothelial dysfunction and is a key driver of cardiovascular risk and complications in patients with RA. Prompt identification of cardiac pathologies in patients with RA is essential for appropriate management and treatment. Choosing the most appropriate treatment regimen is based on individual patient factors. In this article, we provide a comprehensive review of the epidemiology, pathophysiology, clinical manifestations, diagnosis, and medical management of cardiovascular manifestations of RA. We also discuss the relationship between anti-rheumatic medications, specifically non-steroidal anti-inflammatory drugs, corticosteroids, methotrexate, statins, tumor necrosis factor inhibitors, interleukin-6 inhibitors, Janus kinase inhibitors, and cardiovascular disease.

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Section: Cardiac Manifestationsmentioning

confidence: 99%

Section: Cardiac Manifestationsmentioning

confidence: 99%

Cardiovascular Manifestations in Rheumatoid Arthritis

Sanghavi

Ingressia

Korem

et al. 2022

Cardiology in Review

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“…Since the disease is systemic, it affects many organs, including the heart, which can lead to coronary artery disease, pericarditis, and heart failure [ 1 ]. The most common cardiac complication from RA is pericarditis, which accounts for almost 40% of cases and leads to fluid collection in the pericardium [ 1 , 2 ]. Most patients are asymptomatic; at most, 10% have the symptoms of pericarditis [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Pericardial Effusion as a First Manifestation of Rheumatoid Arthritis: A Case Report

Alqahtani,

Alashhab,

Manasfi

et al. 2023

Cureus

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Rheumatoid arthritis (RA) is a systemic autoimmune disease that mainly affects the joints, which can lead to joint deformity. Since the disease is systemic, it affects many organs, including the heart, which can lead to pericarditis, coronary artery disease, and heart failure. We are reporting on a male patient, 34 years of age and Sudanese, who complained of shortness of breath and chest pain that started weeks before he came to the hospital, with no other associated symptoms. The patient was admitted to the hospital, and extensive work was done for the patient, which revealed that he had pericardial effusion secondary to RA, which is the first presentation of the disease. RA rarely presents as a first presentation with pericarditis and pericardial effusion. The patient was managed medically, and he showed significant improvement.

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“…Therefore, the complication of pericarditis-associated rheumatoid arthritis could be related to the disease severity of rheumatoid arthritis, and individuals with more severe rheumatoid arthritis are at a greater risk of developing pericarditis [5,7]. However, in many cases, cardiac tamponade does not occur and the condition is relieved by continued drug treatment [8].…”

Section: Introductionmentioning

confidence: 99%

Pericarditis With Cardiac Tamponade Mimicking Yellow Nail Syndrome in a Patient With Rheumatoid Arthritis and a Paucity of Joint Symptoms

Tokonami¹,

Ohta²,

Tanaka³

et al. 2022

Cureus

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Pericarditis is a cardiac disease that commonly manifests with rheumatoid arthritis, and its complications are related to rheumatoid arthritis disease activity. The diagnosis can be complicated in patients with multiple extra-joint complications of rheumatoid arthritis. We report a case of pericarditis in an 82-year-old woman with few joint symptoms who was admitted to the hospital due to worsening edema of the lower legs and dyspnea, which progressed to cardiac tamponade. The patient presented with gradual onset of edema of both lower limbs and bilateral pleural effusion and was initially diagnosed with yellow nail syndrome. Ultimately, the patient was diagnosed with rheumatoid pericarditis due to a rapid increase in pericardial effusion. She was treated with non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine; however, the symptoms were progressive and required pericardiocentesis. After pericardiocentesis, the patient responded well to NSAIDs and colchicine, and systemic edema was relieved. This case highlights the fact that pericarditis associated with rheumatoid arthritis is not necessarily related to the severity of joint symptoms. Moreover, it can be difficult to differentiate pericarditis from multiple other diseases, such as yellow nail syndrome, in patients with rheumatoid arthritis who mainly have extra-articular symptoms.

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Chest Pain Due to Pericardial Effusion as Initial Presenting Feature of Rheumatoid Arthritis: Case Report and Review of the Literature

Cited by 9 publications

References 15 publications

Cardiovascular Manifestations in Rheumatoid Arthritis

Cardiovascular Manifestations in Rheumatoid Arthritis

Pericardial Effusion as a First Manifestation of Rheumatoid Arthritis: A Case Report

Pericarditis With Cardiac Tamponade Mimicking Yellow Nail Syndrome in a Patient With Rheumatoid Arthritis and a Paucity of Joint Symptoms

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