title: Pericardial mass in a patient with rheumatoid arthritis.
abstract: A 65-year-old man presented with long-standing rheumatoid arthritis (RA), severe fatigue and mild arthritis of metacarpophalaneal joints. Physical examination revealed S3, II/IV decrescendo diastolic murmur and 2+ LL oedema. Anticyclic citrullinated peptide antibodies were >250 units. Echocardiogram showed an 8 cm pericardial mass with no atrial or ventricular collapse and mild to moderate aortic regurgitation. Cardiac MRI defined the mass as a heterogeneous entity attached to the right, anterior and inferior heart borders, with compression on right cardiac structures and the left ventricle. CT-guided biopsy demonstrated fibrinous material without granulomas or infection. Fatigue did not improve on immunosuppression with low-dose prednisone and leflunamide. Cardiac tamponade was confirmed by heart catheterisation and the mass was surgically excised with partial pericardiectomy. The patient had a dramatic improvement and, 4 years later, he remains asymptomatic cardiac wise. This case highlights the clinical significance of pericardial disease in RA and its response to therapy.
authors.affiliation: Department of Internal Medicine, University of Florida, Gainesville, Florida, USA.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Al-Ani
authors.affiliation: Department of Pathology, Malcom Randall VAMC, NF/SGVHS, Gainesville, Florida, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Weber
authors.affiliation: Department of Internal Medicine - Division of Cardiology, University of Florida, Gainesville, Florida, USA.
authors.forename: David
authors.initials: D
authors.lastname: Winchester
authors.affiliation: Department of Internal Medicine - Division of Rheumatology, Malcom Randall VAMC, NF/SGVHS, Gainesville, Florida, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Kosboth
mesh_terms: D000368:Aged; D000906:Antibodies / Q000097:blood; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000601:surgery; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000473:pathology; D002305:Cardiac Tamponade / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D004452:Echocardiography; D006321:Heart; D006337:Heart Murmurs / Q000209:etiology / Q000601:surgery; D006338:Heart Neoplasms / Q000097:blood / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D010490:Pericardial Effusion / Q000209:etiology / Q000601:surgery; D010492:Pericardiectomy; D010493:Pericarditis / Q000209:etiology / Q000601:surgery; D010496:Pericardium / Q000473:pathology* / Q000601:surgery
chemical_list: D000906:Antibodies