Recurrent pericardial effusion: An extra-articular manifestation of undiagnosed seropositive rheumatoid arthritis
Background: Rheumatoid arthritis (RA) is a multisystemic chronic inflammatory autoimmune disorder that predominantly affects peripheral joints in a symmetrical pattern. While extraarticular manifestations are rarely the first sign of undiagnosed RA, cardiovascular involvement can present as endo...
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my.unimas.ir-467882024-12-04T00:58:13Z http://ir.unimas.my/id/eprint/46788/ Recurrent pericardial effusion: An extra-articular manifestation of undiagnosed seropositive rheumatoid arthritis Lau, Wen Jie Lai, Be Jinn Leong, Lai Kuan Sharifah Aishah, Wan Mohamad Akbar Ahmad Tirmizi, Jobli R Medicine (General) Background: Rheumatoid arthritis (RA) is a multisystemic chronic inflammatory autoimmune disorder that predominantly affects peripheral joints in a symmetrical pattern. While extraarticular manifestations are rarely the first sign of undiagnosed RA, cardiovascular involvement can present as endocarditis, myocarditis, pericarditis, pericardial effusion (PE), valvular heart disease, amyloidosis, heart failure, and arrhythmia. Importantly, RA patients have a 50% higher risk of cardiovascular mortality compared to general population. Case Report: A 41-year- old Malay lady admitted to Sarawak Heart Centre in October 2023 with a 2-week history of reduced effort tolerance and bilateral lower limb swelling. Upon arrival, her vital signs were: BP: 123/78 mmHg, HR: 100/min, SPO2: 98% under room air. Chest X-ray showed cardiomegaly with normal sinus rhythm from ECG. Laboratory tests showed haemoglobin: 9.3 g/dL, total white cell: 8.13 x 109/L, platelet: 489 x 109/L, urea: 8.5 mmol/L, creatinine: 67 μmol/L, total bilirubin: 8.3 μmol/L, AST: 20 U/L, ALT: 10 U/L, albumin: 32 g/L, CRP: 573.8 mg/L. Echocardiography revealed global PE, largest at left ventricular posterior wall (LV-PW) measuring 2.7 cm with normal ejection fraction. 590 mL haemorrhagic fluids was aspirated from pericardiocentesis. Analysis of the PE showed an exudative picture. Investigations for tuberculosis and malignancy were negative. A CT scan of the thorax, abdomen and pelvis was normal. ANA, C3 and C4 were normal. She received 2-week course antibiotics and was started on colchicine 0.5mg once daily. 1 month later, she was admitted to Bintulu Hospital, Sarawak for acute decompensated heart failure. Troponin I: 0.06 ng/ml. Repeated echocardiography showed moderate global PE, largest measured 1.5cm at LV-PW. Serial blood and fungal cultures revealed no growth. It was noted that she had right wrist pain for the past 16 years, followed by a 1-month history of multiple joint pains. Examination showed arthritis of the bilateral wrists, right 2nd-4th proximal interphalangeal joints, right elbow, right shoulder and bilateral ankles. There were no rheumatoid nodules. X-rays showed erosive changes over the right wrist. Serum rheumatoid factor was positive. She was finally diagnosed with seropositive erosive rheumatoid arthritis with pericardial effusion as the extra-articular manifestation. She was treated with a short course of steroids and weekly methotrexate. Conclusion: Recurrent PE should prompt consideration of RA as a potential diagnosis once all infectious and non-infectious causes have been thoroughly investigated. A comprehensive evaluation based on detailed history-taking and physical examination can greatly influence treatment outcomes. John Wiley & Sons, Inc. 2024-11-14 Article PeerReviewed text en http://ir.unimas.my/id/eprint/46788/1/Publication%20Evidence.pdf Lau, Wen Jie and Lai, Be Jinn and Leong, Lai Kuan and Sharifah Aishah, Wan Mohamad Akbar and Ahmad Tirmizi, Jobli (2024) Recurrent pericardial effusion: An extra-articular manifestation of undiagnosed seropositive rheumatoid arthritis. International Journal of Rheumatic Diseases, 27 (S3). p. 215. ISSN 1756-185X https://onlinelibrary.wiley.com/toc/1756185x/2024/27/S3 |
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R Medicine (General) Lau, Wen Jie Lai, Be Jinn Leong, Lai Kuan Sharifah Aishah, Wan Mohamad Akbar Ahmad Tirmizi, Jobli Recurrent pericardial effusion: An extra-articular manifestation of undiagnosed seropositive rheumatoid arthritis |
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Background: Rheumatoid arthritis (RA) is a multisystemic chronic
inflammatory autoimmune disorder that predominantly affects peripheral
joints in a symmetrical pattern. While extraarticular manifestations
are rarely the first sign of undiagnosed RA, cardiovascular
involvement can present as endocarditis, myocarditis, pericarditis,
pericardial effusion (PE), valvular heart disease, amyloidosis, heart
failure, and arrhythmia. Importantly, RA patients have a 50% higher
risk of cardiovascular mortality compared to general population.
Case Report: A 41-year-
old
Malay lady admitted to Sarawak Heart
Centre in October 2023 with a 2-week
history of reduced effort tolerance
and bilateral lower limb swelling. Upon arrival, her vital signs
were: BP: 123/78 mmHg, HR: 100/min, SPO2: 98% under room air.
Chest X-ray
showed cardiomegaly with normal sinus rhythm from
ECG. Laboratory tests showed haemoglobin: 9.3 g/dL, total white
cell: 8.13 x 109/L, platelet: 489 x 109/L, urea: 8.5 mmol/L, creatinine:
67 μmol/L, total bilirubin: 8.3 μmol/L, AST: 20 U/L, ALT: 10 U/L, albumin:
32 g/L, CRP: 573.8 mg/L. Echocardiography revealed global
PE, largest at left ventricular posterior wall (LV-PW)
measuring 2.7
cm with normal ejection fraction. 590 mL haemorrhagic fluids was
aspirated from pericardiocentesis. Analysis of the PE showed an exudative
picture. Investigations for tuberculosis and malignancy were
negative. A CT scan of the thorax, abdomen and pelvis was normal.
ANA, C3 and C4 were normal. She received 2-week
course antibiotics
and was started on colchicine 0.5mg once daily. 1 month later,
she was admitted to Bintulu Hospital, Sarawak for acute decompensated
heart failure. Troponin I: 0.06 ng/ml. Repeated echocardiography
showed moderate global PE, largest measured 1.5cm at
LV-PW.
Serial blood and fungal cultures revealed no growth. It was
noted that she had right wrist pain for the past 16 years, followed
by a 1-month
history of multiple joint pains. Examination showed
arthritis of the bilateral wrists, right 2nd-4th
proximal interphalangeal
joints, right elbow, right shoulder and bilateral ankles. There were no
rheumatoid nodules. X-rays
showed erosive changes over the right
wrist. Serum rheumatoid factor was positive. She was finally diagnosed
with seropositive erosive rheumatoid arthritis with pericardial
effusion as the extra-articular
manifestation. She was treated with a
short course of steroids and weekly methotrexate.
Conclusion: Recurrent PE should prompt consideration of RA as a
potential diagnosis once all infectious and non-infectious
causes have been thoroughly investigated. A comprehensive evaluation
based on detailed history-taking
and physical examination can
greatly influence treatment outcomes. |
format |
Article |
author |
Lau, Wen Jie Lai, Be Jinn Leong, Lai Kuan Sharifah Aishah, Wan Mohamad Akbar Ahmad Tirmizi, Jobli |
author_facet |
Lau, Wen Jie Lai, Be Jinn Leong, Lai Kuan Sharifah Aishah, Wan Mohamad Akbar Ahmad Tirmizi, Jobli |
author_sort |
Lau, Wen Jie |
title |
Recurrent pericardial effusion: An extra-articular manifestation of undiagnosed seropositive rheumatoid arthritis |
title_short |
Recurrent pericardial effusion: An extra-articular manifestation of undiagnosed seropositive rheumatoid arthritis |
title_full |
Recurrent pericardial effusion: An extra-articular manifestation of undiagnosed seropositive rheumatoid arthritis |
title_fullStr |
Recurrent pericardial effusion: An extra-articular manifestation of undiagnosed seropositive rheumatoid arthritis |
title_full_unstemmed |
Recurrent pericardial effusion: An extra-articular manifestation of undiagnosed seropositive rheumatoid arthritis |
title_sort |
recurrent pericardial effusion: an extra-articular manifestation of undiagnosed seropositive rheumatoid arthritis |
publisher |
John Wiley & Sons, Inc. |
publishDate |
2024 |
url |
http://ir.unimas.my/id/eprint/46788/1/Publication%20Evidence.pdf http://ir.unimas.my/id/eprint/46788/ https://onlinelibrary.wiley.com/toc/1756185x/2024/27/S3 |
_version_ |
1817848781044973568 |
score |
13.222552 |