Concomitant Large Loculated Pleural and Pericardial Effusions in a Patient with Rheumatoid Arthritis on Methotrexate

Whitfield, Nakiya; Krasniak, Anne; Nguyen, Hien

doi:10.7812/tpp/19.239

Cited by 5 publications

(6 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thus, systemic inflammation is at play, as evidenced by Thompson et al [10], who found that 88 of 1,058 patients (8.3%) with granulomatosis and polyangiitis, 27 of 267 (10.1%) with microscopic polyangiitis, and 35 of 201 (17.4%) with eosinophilic granulomatosis with polyangiitis had pleural and pericardial involvement. This has also been described in patients with rheumatoid arthritis, with one notably requiring intravenous immunosuppression, conventional chest drainage, and surgical treatment for the pleural effusions [11]. Other causes described in the literature include chlamydia pneumonia [12], yellow nail syndrome [13], and following anti-cancer treatment [14].…”

Section: Discussionmentioning

confidence: 98%

Pleural Effusions and Pericarditis: A Retrospective Cohort Study of Patients Undergoing Cardiac Magnetic Resonance Imaging

Ahmed¹,

Aujayeb²

2022

Cureus

View full text Add to dashboard Cite

BackgroundPleural effusions can occur due to acute pericarditis and can necessitate intervention. We sought to add to the evidence base by performing a retrospective review of patients presenting to the advanced cardiac imaging unit with pericarditis and pleural effusion to determine laterality, trends in pleural fluid analyses, and the need for pleural intervention. Local ethical (Caldicott) approval was obtained for this study. MethodologyDescriptive statistical methodology was applied with continuous data presented as mean (standard deviation, SD; range) and categorical variables as frequencies or percentages. ResultsIn 60 patients with pericarditis, 24 (39%) had pleural effusions on contemporaneous imaging. The mean age of the study population was 63.3 years (range: 20-83), and 17 patients were males. Diagnoses were viral (five), rheumatological (one), amyloidosis (one), listeria (one), and the rest idiopathic (17). Four effusions were only left-sided, one right-sided, and 20 bilateral. Ten pleural taps were performed, one for a unilateral effusion and nine for one side being bigger than the other. The mean pH was 7.46 (7.33-7.6), mean lactate dehydrogenase was 210 (74-393 U/L), mean fluid protein was 36.1 (19-56 g/L) (four effusions exudative/three transudative), mean glucose was 5.8 (4.8-6.8 mmol/L), and all cytologies were negative. Five patients underwent large volume aspirations for symptom control. Three indwelling pleural catheters (IPC) were placed for treatment refractory effusions. There was one pleural space infection in six months related to an IPC. There were three deaths at 12 months, with none related to pericarditis. ConclusionsPleural effusions associated with pericarditis are usually small, bilateral, and exudative. Treatment refractory cases require pleural intervention, with aspirations, drains, and IPCs being viable options. Further prospective studies are warranted.

show abstract

Section: Discussionmentioning

confidence: 98%

Pleural Effusions and Pericarditis: A Retrospective Cohort Study of Patients Undergoing Cardiac Magnetic Resonance Imaging

Ahmed¹,

Aujayeb²

2022

Cureus

View full text Add to dashboard Cite

show abstract

“…The major clinical feature of RA is inflammation and erosion of synovial joints in a typically symmetrical form, which, if uncontrolled, can lead to erosion of cartilage and bone, causing joint deformities and irreversible disability [ 6 , 7 ] . The disease may also cause the presence of fever, weight loss and fatigue [ 4 ] . Since RA is a systemic disease, other organs can be affected, such as skin, eyes, lungs and heart [ 2 ] .…”

Section: Discussionmentioning

confidence: 99%

“…The cardiac involvement by RA is relatively frequent and can occur in the form of pericarditis, pericardial effusion (mostly without tamponade) and conduction abnormalities [ 3 ] . Patients may rarely present extra-articular disease in the absence of clinical arthritis; however, this is rarely the presenting sign of undiagnosed RA [ 4 ] . We report a case of 82-year-old male with recurrent pericardial effusion as the sole presentation of RA.…”

Section: Introductionmentioning

confidence: 99%

Rheumatoid arthritis and pericardial effusion – a unique major manifestation

Cruz,

Bragança,

Lopes

et al. 2024

European Journal of Case Reports in Internal Medicine

View full text Add to dashboard Cite

Introduction: Pericardial effusion is common in the setting of rheumatoid arthritis (RA); however, it is rarely its first manifestation. Case description: An 82-year-old male presented with abdominal pain, vomiting and fever. Blood analysis revealed elevated systemic inflammatory markers, and an abdominal computed tomography scan revealed non-specific alveolar condensation of the right pulmonary base and pericardial effusion subsequently quantified as medium size by transthoracic echocardiography. A large aetiological panel was requested, with the autoimmunity study revealing high levels of rheumatoid factor (RF) and anti-citrullinated cyclic peptide (anti-CCP) antibodies. Since the patient did not present articular involvement, the initial hypothesis was pericardial effusion due to pneumonia and no specific treatment for RA was started. At follow-up, the pericardial effusion recurred and a pericardiocentesis was performed. The pericardial fluid analysis was sterile, and no malignant cells were identified. A new serological study confirmed high levels of RF and anti-CCP antibodies, and immunomodulatory treatment was initiated. After one year, the pericardial effusion recurred due to non-compliance with immunomodulatory therapy. A surgical pleuro-pericardial window was performed, and the cytological study of the pericardial patch revealed submesothelial thickening and foci of perivascular lymphocytic infiltrate. The patient remained asymptomatic. Discussion: After exclusion of a large spectrum of infectious and non-infectious causes and the relapse after suspension of immunomodulatory treatment, the most probable aetiology for the pericardial effusion remains RA. Conclusion: Pericardial syndromes can be the first manifestation of AR even in the absence of articular symptoms and this disease must be considered in the aetiological investigation.

show abstract

“…It is important to note that, while these cases suggest an association between the use of MTX and pericardial or pleural effusion, further research is needed to establish a causal relationship. Close monitoring of patients using MTX for potential adverse events such as pericardial effusion is crucial, and any symptoms should be reported to their healthcare provider [1,13,[16][17][18][19][20].…”

Section: Table 2: Summary Of Reviewed Casesmentioning

confidence: 99%

“…Rheumatoid arthritis (RA) is a systemic inflammatory disease associated with high mortality and a relatively poor prognosis. Factors associated with a worse prognosis of the disease include positive anti-citrullinated antibodies with seropositive rheumatoid factor, anemia of chronic disease, and extra-articular manifestations [ 1 ]. Methotrexate (MTX) is a chemotherapeutic and immunosuppressive drug commonly used for RA treatment.…”

Section: Introductionmentioning

confidence: 99%

Pericarditis Induced by Methotrexate: A Case Report and Literature Review

Guevara¹,

Hernandez²,

Rosado³

et al. 2023

Cureus

View full text Add to dashboard Cite

Methotrexate (MTX) is a crucial part of the management of rheumatoid arthritis (RA). Although MTX is generally well tolerated, it is not exempt from adverse effects. The side effects of MTX are diverse, and pericarditis, as demonstrated in our case, is one of the rarest adverse effects. Therefore, it is crucial to rule out common causes of pericarditis, such as infections, malignancies, or other underlying conditions. However, once common causes are excluded, MTX-induced pericarditis should always be considered, and MTX should be discontinued without resumption due to potential relapse. Furthermore, the timing of MTX initiation is not significant; patients may have been on chronic MTX treatment or have recently started it. Moreover, pericarditis secondary to MTX is not exclusive to patients with rheumatological conditions but can also occur in other conditions.

show abstract

Concomitant Large Loculated Pleural and Pericardial Effusions in a Patient with Rheumatoid Arthritis on Methotrexate

Cited by 5 publications

References 23 publications

Pleural Effusions and Pericarditis: A Retrospective Cohort Study of Patients Undergoing Cardiac Magnetic Resonance Imaging

Pleural Effusions and Pericarditis: A Retrospective Cohort Study of Patients Undergoing Cardiac Magnetic Resonance Imaging

Rheumatoid arthritis and pericardial effusion – a unique major manifestation

Pericarditis Induced by Methotrexate: A Case Report and Literature Review

Contact Info

Product

Resources

About