Cardiac compression in rheumatoid pericarditis

• Published in: Seminars in arthritis and rheumatism Vol. 20; no. 3; pp. 148 - 163
• Main Authors: Escalante, Agustin, Kaufman, Ronald L., Quismorio, Francisco P., Beardmore, Thomas D.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.12.1990; Elsevier
• Subjects: Adrenal Cortex Hormones - therapeutic use; Adult; Aged; Arthritis, Rheumatoid - complications; Biological and medical sciences; Constriction, Pathologic - diagnosis; Diseases of the osteoarticular system; Drainage; Echocardiography; Female; Heart - physiopathology; Humans; Inflammatory joint diseases; Male; Medical sciences; Middle Aged; Pericardial Effusion - diagnosis; Pericardial Effusion - surgery; Pericarditis - diagnosis; Pericarditis - etiology; Pericarditis - surgery; Pericardium - pathology; Pressure; Radiography, Thoracic; cardiac tamponade; constrictive pericarditis; rheumatoid arthritis; Pericardial effusion; Heart; Human; Pericarditis; Symptomatology; Chronic; Compression; Rheumatoid arthritis; Diseases of the osteoarticular system; Cardiovascular disease; Autoimmune disease; Inflammatory joint disease; Tamponade
• ISSN: 0049-0172; 1532-866X
• DOI: 10.1016/0049-0172(90)90056-L

Rheumatoid pericarditis occurs in approximately one third of rheumatoid arthritis (RA) patients. However, clinically apparent rheumatoid pericarditis is infrequent. The authors found clinical pericarditis in 12 of 960 patients admited for RA, 5 of whom had manifestations of cardiac compression. These 5 had longer duration of RA, worse functional class, and more extraarticular features than the patients without cardiac compression. Presenting features of cardiac compression included dyspnea, edema, chest pain, and pulsus paradoxus. Treatment of patients with cardiac compression due to rheumatoid pericarditis may include a trial of systemically administered corticosteroids, but this should not delay surgical intervention for impending tamponade. Pericardiocentesis should only be performed as an emergency, life-saving procedure. It may be followed by intrapericardiac injection of corticosteroids, but this does not prevent recurrence. Longer-lasting benefit is obtained by surgical decompression. Two-year mortality in patients with cardiac compression was 100%. The literature on the subject is reviewed.