Rheumatoid pericarditis with cardiac failure treated by pericardiectomy.

Abstract

Pericarditis is recognized as a common finding at necropsy in patients with rheumatoid arthritis, but the existence of various clinical syndromes associated with rheumatoid pericarditis is less widely appreciated. Transient acute pericarditis with friction, pericardial effusion, cardiac tam- ponade, and chronic constrictive pericarditis have all been described. Fifteen patients with chronic rheumatoid arthritis who had undergone pericardiectomy have been reported in the English language at the time of writing. The majority of these benefited from surgical treatment (Table The patient described by Szatkowski and Inoue (1963) had rheumatoid arthritis, but his chronic effusive pericarditis was assumed to be of tuberculous origin despite failure to isolate any tubercle bacilli. This paper describes 3 patients with symptomatic rheumatoid pericarditis treated by pericardiectomy. One of these patients (Case 1) has been briefly described in a previous communication (Partridge and Duthie, 1963). CASE REPORTS Case 1. A man aged 49 years, formerly a foundry worker, had experienced transient joint pains at the age of 35. Five years before he was admitted to hospital he developed a right pleural effusion with opacities in both lung fields, and for more than two years was given anti- tuberculosis chemotherapy in the belief that he had pulmonary tuberculosis, despite repeated failure to culture tubercle bacilli from the sputum. A year later, at 45, he developed pain in the elbows and shoulders, with spindling of the fingers and subcutaneous nodules at the elbows and wrist. Radiographs showed erosions of the metatarsal heads. After in-patient treatment for rheumatoid arthritis his functional capacity remained