SHM Converge Scientific Abstract ePoster Gallery-An Unique Onset of Rheumatoid Arthritis: Acute Pericarditis

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This case report describes a 49-year-old woman whose initial presentation of rheumatoid arthritis (RA) was acute pericarditis with cardiac tamponade physiology, an unusual first manifestation of the disease. She came to the emergency department with fever, shortness of breath, chest pain, and right upper quadrant abdominal pain, along with a five- to six-month history of intermittent bilateral arthralgias in the knees, shoulders, and wrists. Physical exam showed a positive Murphy sign, raising concern for acute cholecystitis. However, imaging revealed an enlarged cardiac silhouette on chest X-ray and CT, and transthoracic echocardiography showed a large pericardial effusion with right heart strain and tamponade features. Inflammatory markers were elevated, and both rheumatoid factor and CCP antibodies were positive, confirming RA. A HIDA scan was negative, supporting that the abdominal pain was not due to cholecystitis.<br /><br />The patient improved dramatically after pericardiocentesis, with about 500 mL of fluid removed, and a drain was left in place for 24 hours without recurrence of effusion. She was then started on high-dose steroids with plans to transition to a steroid-sparing regimen, including methotrexate.<br /><br />The report emphasizes that RA can present with extra-articular manifestations, including pericarditis, even in patients who do not fit the classic demographic of older adults. It also highlights the risk of diagnostic anchoring on abdominal findings such as a positive Murphy sign, when the true source of symptoms may be cardiac. The authors recommend considering RA serologies in patients with elevated inflammatory markers and imaging suggestive of pericarditis, especially when joint symptoms are present.

Asset Subtitle

Nisha N. Patel

Meta Tag

Author List Josh Morris, Nisha N. Patel

Category Clinical Vignettes

Concept Rheumatoid Arthritis

Concept Pericarditis

Concept Pericardial Effusion

Concept Cardiac Tamponade

Concept Pericardiocentesis

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Nisha N. Patel

Track Adult

Keywords

rheumatoid arthritis

acute pericarditis

cardiac tamponade

pericardial effusion

pericardiocentesis

rheumatoid factor

CCP antibodies

extra-articular manifestations

Murphy sign

methotrexate

Rheumatoid Arthritis

Pericarditis

Pericardial Effusion

Cardiac Tamponade

Pericardiocentesis