Tokonami Ayuko, Ohta Ryuichi, Tanaka Yudai, Amano Shiho, Sano Chiaki
Family Medicine, Shimane University, Izumo, JPN.
Community Care, Unnan City Hospital, Unnan, JPN.
Cureus. 2022 Jan 23;14(1):e21523. doi: 10.7759/cureus.21523. eCollection 2022 Jan.
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.
心包炎是一种常与类风湿关节炎同时出现的心脏疾病，其并发症与类风湿关节炎的疾病活动相关。对于患有类风湿关节炎多种关节外并发症的患者，诊断可能会很复杂。我们报告一例82岁女性心包炎病例，该患者关节症状较少，因下肢水肿加重和呼吸困难入院，病情进展为心脏压塞。患者表现为双下肢逐渐出现水肿和双侧胸腔积液，最初被诊断为黄甲综合征。最终，由于心包积液迅速增加，患者被诊断为类风湿性心包炎。她接受了非甾体抗炎药（NSAIDs）和秋水仙碱治疗；然而，症状仍在进展，需要进行心包穿刺术。心包穿刺术后，患者对NSAIDs和秋水仙碱反应良好，全身水肿得到缓解。该病例突出了这样一个事实，即与类风湿关节炎相关的心包炎不一定与关节症状的严重程度相关。此外，对于主要有关节外症状的类风湿关节炎患者，很难将心包炎与多种其他疾病（如黄甲综合征）区分开来。
