Kelly C A, Bourke J P, Malcolm A, Griffiths I D
Department of Rheumatology, Freeman Hospital, Newcastle upon Tyne.
Q J Med. 1990 May;75(277):461-70.
We have reviewed the clinical and investigative findings in 13 patients with chronic pericardial disease and seropositive rheumatoid arthritis. In eleven cases the diagnosis was made on clinical grounds, while the diagnosis was confirmed only at post-mortem in two patients. Pleural effusions were present in seven patients, while pulsus paradoxus was found in only one case. Echocardiograms were undertaken in ten patients and all showed evidence of pericardial effusions, which were usually small and sited posteriorly. A delayed ventricular filling pattern indicating abnormal ventricular relaxation was seen in two patients with cardiac tamponade. The surviving 11 patients were reviewed a median of three years after diagnosis of their pericardial disease. Pericardectomy had been performed in six, all of whom were asymptomatic and had a normal chest radiograph. Steroids alone had been given to the other five, and three of these remained dyspnoeic with cardiomegaly. The clinical features distinguishing chronic pericardial disease from other causes of right heart failure in rheumatoid arthritis patients are subtle. As management is fundamentally different, serious consideration should be given to the diagnosis of chronic pericardial disease in any patient with rheumatoid arthritis who presents with right-sided heart failure.
我们回顾了13例慢性心包疾病合并血清学阳性类风湿关节炎患者的临床及检查结果。11例根据临床症状做出诊断，另外2例仅在尸检时确诊。7例患者出现胸腔积液，仅1例发现奇脉。10例患者进行了超声心动图检查，均显示有心包积液，积液通常较小且位于后方。2例心脏压塞患者出现心室充盈延迟模式，提示心室舒张异常。在诊断心包疾病后的中位时间为三年时，对存活的11例患者进行了复查。6例患者接受了心包切除术，所有患者均无症状且胸部X线片正常。另外5例仅接受了类固醇治疗，其中3例仍有呼吸困难且伴有心脏扩大。类风湿关节炎患者中，慢性心包疾病与其他导致右心衰竭的病因在临床特征上较为细微。由于治疗方法根本不同，对于任何出现右心衰竭的类风湿关节炎患者，都应认真考虑慢性心包疾病的诊断。
