title: Severe extra-articular manifestations of rheumatoid arthritis in absence of concomitant joint involvement following long-term spontaneous remission. A case report.
abstract: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease occasionally associated with severe extra-articular manifestations, mostly in cases of longstanding highly active disease. We report the case of a 56 year-old woman diagnosed with active RA at the age of 40. After 5 years of high activity, her arthritis subsides spontaneously during pregnancy despite the lack of treatment with disease-modifying anti-rheumatic drugs. She remains without articular symptoms for 7 years, and then she develops a Felty's syndrome requiring steroid treatment and splenectomy. Following steroid withdrawal she develops pericarditis with massive serohematic pericardial effusion, still in absence of articular activity, and responds to immunosuppressive therapy and colchicine. We emphasize the unusual spontaneous and sustained joint remission without specific treatment, and the development of severe extra-articular manifestations of RA in absence of concomitant articular activity, as well as the importance of controlling inflammation.
authors: Servicio de Clínica Médica, Hospital Provincial del Centenario , Rosario, Santa Fe, Argentina. Electronic address: marianalagrutta@gmail.com.
authors: Mariana
authors: M
authors: Lagrutta
authors: Servicio de Clínica Médica, Hospital Provincial del Centenario , Rosario, Santa Fe, Argentina.
authors: Gelsomina
authors: G
authors: Alle
authors: Servicio de Clínica Médica, Hospital Provincial del Centenario , Rosario, Santa Fe, Argentina.
authors: Roberto Leandro
authors: RL
authors: Parodi
authors: Servicio de Clínica Médica, Hospital Provincial del Centenario , Rosario, Santa Fe, Argentina.
authors: Alcides Alejandro
authors: AA
authors: Greca
mesh_terms: D001172:Arthritis, Rheumatoid / Q000503:physiopathology; D005258:Felty Syndrome / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012075:Remission, Spontaneous
keywords: Artritis reumatoide; Embarazo; Extra-articular manifestations; Felty's syndrome; Manifestaciones extraarticulares; Pericarditis; Pregnancy; Remisión espontánea; Rheumatoid arthritis; Spontaneous remission; Síndrome de Felty