Rheumatoid arthritis can rarely present initially as life-threatening cardiac tamponade, requiring early recognition and immunomodulatory therapy to prevent recurrence.
Rheumatoid arthritis can rarely present initially as life-threatening cardiac tamponade, highlighting the need to consider autoimmune etiologies in pericardial disease and the importance of early immunomodulatory therapy.
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Abstract Introduction Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by inflammatory polyarthritis and the presence of autoantibodies such as rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (ACPA). As a systemic disease, RA can involve multiple organ systems, including the heart. Pericarditis is a known but uncommon cardiac manifestation that may progress to pericardial effusion and, rarely, cardiac tamponade. It is unusual for RA to initially present with pericardial involvement. We describe a case of RA-induced pericarditis leading to cardiac tamponade as the first manifestation of disease. Case Presentation A 47-year-old woman with no prior medical history presented with two weeks of dyspnea and cough following a recent upper respiratory infection. On admission, she was tachycardic, tachypneic, and required 2 L of oxygen to maintain an oxygen saturation of 94%. Elevated D-dimer prompted a CT angiography (CTA) of the chest, which was negative for pulmonary embolism but revealed a large pericardial effusion with interventricular septal strain. Transthoracic echocardiography confirmed the finding. While awaiting a pericardial window, she became hemodynamically unstable and underwent emergent pericardiocentesis followed by a pericardial window. Pericardial fluid cultures were negative, and pathology showed benign tissue with chronic inflammation. Further history revealed a family history of rheumatoid arthritis. Laboratory evaluation demonstrated positive RF, ACPA, and elevated ESR and CRP. Rheumatology was consulted, but the patient preferred outpatient follow-up and was discharged on colchicine 0.6 mg twice daily. Two months later, she was readmitted with dyspnea and pleuritic chest pain worsened by lying flat and deep breathing. Echocardiography showed a small effusion. She was treated with colchicine, prednisone 20 mg daily, ibuprofen, and protonix. Outpatient rheumatology initiated methotrexate 15 mg weekly and tapered prednisone to 15 mg daily. Over the next year, she remained stable with no recurrence of pericardial effusion. Discussion Pericarditis as the initial manifestation of RA is rare but may result in life-threatening tamponade. This case underscores the importance of considering autoimmune etiologies in patients presenting with pericardial disease. Early recognition and immunomodulatory therapy, including corticosteroids and methotrexate, are essential to prevent recurrence and ensure long-term stability. This abstract is funded by: None
Xiong et al. (Fri,) reported a other. Rheumatoid arthritis can rarely present initially as life-threatening cardiac tamponade, requiring early recognition and immunomodulatory therapy to prevent recurrence.