Summary
In order to clarify the significance of rheumatoid arthritis (RA) as a cause of cardiac compression, we scrutinized pericardiectomy files of 47 patients over a ten-year period at two university hospitals in Finland. Five patients with RA were found. All the patients with RA were men with seropositive disease and subcutaneous rheumatoid nodules. Two of the patients had pulmonary fibrosis, one had cutaneous vasculitis and three had had rheumatoid pleurisy. There was a mean delay of 10 months from the first cardiac symptom to the diagnosis of cardiac compression, the most common misdiagnosis being primarily a liver disease. On the basis of clinical and operative data, four out of the five patients had constrictive pericarditis and one had an effusive-constrictive form of the disease. The histopathological findings in all cases were consistent with chronic fibrosing pericarditis. A follow-up of seven to seventeen years of four patients has not revealed any signs of recurrent pericardial disease. Our results demonstrate that RA is an important aetiological factor for cardiac compression. The long-term outcome of this manifestation seems to be good after pericardiectomy.
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MacDonald, W.J. Jr., Crawford, M.H., Klippel, J.H., Zvaifler, N.J., O'Rourke, R.A. Echocardiographic assessment of cardiac structure and function in patients with rheumatoid arthritis. Am J Med 1977, 63, 890–896.
Bonfiglio, T., Atwater, E.C. Heart disease in patients with seropositive rheumatoid arthritis. A controlled autopsy study and review. Arch Intern Med 1969, 124, 714–719.
Escalante, A., Kaufman, R.L., Quismorio, F.P. Jr., Beardmore, T.D. Cardiac compression in rheumatoid pericarditis. Semin Arthritis Rheum 1990, 20, 148–163.
Iveson, J.M.I., Pomerance, A. Cardiac involvement in rheumatoid disease. Clin Rheum Dis 1977, 3, 467–500.
Thadani, U., Iveson, J.M.I., Wright, V. Cardiac tamponade, constrictive pericarditis and pericardial resection in rheumatoid arthritis. Medicine (Baltimore) 1975, 54, 261–270.
Ropes, M.W., Bennett, G.A., Cobb, S., Jacox, R., Jessar, R.A. Revision of diagnostic criteria for rheumatoid arthritis. Bull Rheum Dis 1958, 9, 175–176.
Cooper, D.K.C., Cleland, W.P., Bentall, H.H. Collagen diseases as a cause of constrictive pericarditis. Thorax 1978, 33, 368–371.
Thould, A.K. Constrictive pericarditis in rheumatoid arthritis. Ann Rheum Dis 1986, 45, 89–94.
Publications of the Social Insurance Institution of Finland 1986, T6:20, 157 (In Finnish).
John, J.T. Jr., Hough, A., Sergent, J.S. Pericardial disease in rheumatoid arthritis. Am J Med 1979, 66, 385–390.
Kirk, J., Cosh, J. The pericarditis of rheumatoid arthritis. Q J Med 1969, 38, 397–423.
Sutton, F.J., Whitney, N.O., Applefeld, M.M. The role of echocardiography and computed tomography in the evaluation of constrictive pericarditis. Am Heart J 1985, 109, 350–355.
Soulen, R.L., Stark, D.D., Higgins, C.B. Magnetic resonance imaging of constrictive pericardial disease. Am J Cardiol 1985, 55, 480–484.
Hancock, E.W. Subacute effusive-constrictive pericarditis. Circulation 1971, 43, 183–192.
Jurik, A.G., Graudal, H. Pericarditis in rheumatoid arthritis. A clinical and radiological study. Rheumatol Int 1986, 6, 37–42.
Stastny, P. Rheumatoid arthritis: Relationship with HLA-D. Am J Med 1983, Suppl (December 30), 9–15.
Hakala, M., Tiilikainen, A., Hämeenkorpi, R., Ilonen, J., Jalava, S., Ruuska, P., Mäkitalo, R. Rheumatoid arthritis with pleural effusion includes a subgroup with autoimmune features and HLA-B8, Dw3 association. Scand J Rheumatol 1986, 15, 290–296.
Constrictive pericarditis (Editorial). Lancet 1983, i, 1313–1314.
Burney, D.P., Martin, C.E., Thomas, C.S., Fisher, R.D., Bender, H.W. Jr. Rheumatoid pericarditis. Clinical significance and operative management. J Thorac Cardiovasc Surg 1979, 77, 511–515.
Culliford, A.T., Lipton, M., Spencer, F.C. Operation for chronic constrictive pericarditis: Do surgical approach and degree of pericardial resection influence the outcome significantly? Ann Thor Surg 1980, 29, 147–152.
Walsh, T.J., Baughman, K.L., Gardner, T.J., Bulkley, B.H. Constrictive epicarditis as a cause of delayed or absent response to pericardiectomy. J Thorac Cardiovasc Surg 1982, 83, 126–132.
Hirschmann, J.V. Pericardial constriction. Am Heart J 1978, 96, 110–122.
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Hakala, M., Pettersson, T., Tarkka, M. et al. Rheumatoid arthritis as a cause of cardiac compression. Favourable long-term outcome of pericardiectomy. Clin Rheumatol 12, 199–203 (1993). https://doi.org/10.1007/BF02231526
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DOI: https://doi.org/10.1007/BF02231526