Pulmonary hypertension associated with rheumatoid arthritis: A case report and causal association verification through Mendelian randomization.

RATIONALE

Rheumatoid arthritis (RA) is a chronic systemic autoimmune connective tissue disease characterized by joint swelling and pain, affecting multiple organs. Pulmonary hypertension (PH) is a known but relatively rare pulmonary vascular complication in RA patients. The pathophysiological mechanisms linking RA and PH are diverse, and Mendelian randomization analysis can be used to explore their correlation.

PATIENT CONCERNS

A 43-year-old woman presented with swelling and pain in multiple joints of both hands and dyspnea on exertion lasting over 6 months.

DIAGNOSES

Laboratory tests showed elevated rheumatoid factor, erythrocyte sedimentation rate, C-reactive protein, and anticyclic citrullinated peptide antibody. Echocardiogram revealed PH and mild tricuspid regurgitation. Pulmonary computed tomography scan showed no signs of interstitial lung disease. Pulmonary function tests indicated severe reduction in diffusion capacity and alveolar volume. Right heart catheterization confirmed postcapillary PH with elevated mean pulmonary artery pressure and pulmonary vascular resistance.

INTERVENTIONS

The patient received antirheumatic drugs combined with PH-targeted therapies for 4 months.

OUTCOMES

At follow-up, the patient's pulmonary artery pressure returned to normal levels.

LESSONS

The pathophysiology of RA-associated PH involves multiple inflammatory components. Accurate diagnosis requires right heart catheterization, pulmonary computed tomography, and pulmonary function testing. Combined antirheumatic and PH-targeted treatments can effectively reduce autoantibody levels and alleviate PH.