The majority of patients develop pericarditis after the onset of rheumatoid arthritis; however, pericarditis may precede rheumatoid arthritis (RA) in some patients due to the complications of the inflammation process that can occur during, or after a pericarditis flare. Evaluating the origin of pericardial effusion in patients may help with the early diagnosis of rheumatoid arthritis. The earlier Pericarditis and Rheumatoid Arthritis is diagnosed, the more effectively it can be treated.
Most forms of arthritis are autoimmune disorders, which means that the body’s immune system – which normally helps to fight off bacteria or viruses – mistakenly attacks some of its own healthy cells and tissues. The result is inflammation, redness, heat, pain, and swelling. Inflammation can cause joint damage.
Doctors do not know why the immune system attacks healthy tissues in patients who develop RA. Scientists suspect that it is a two-step process.
First, genetics determine whether or not a patient is genetically predisposed to develop RA, and then an environmental factor, such as a virus, triggers the development of the disease. When these foreign invaders take over, the body produces proteins called antibodies. Antibodies attach to these invaders so that they can be recognized and destroyed.
In an autoimmune reaction, the antibodies attach to the body’s own healthy tissues by mistake, signaling the body to attack them instead. Because they target the self, these proteins are called autoantibodies.
Like autoimmune disorders, auto-inflammatory conditions cause inflammation. And like autoimmune disorders, they also involve an overactive immune system. However, auto-inflammation is not caused by antibodies.
What Happens In Pericarditis and Rheumatoid Arthritis?
“Instead, auto-inflammation involves a more primitive part of the immune system – the part of the immune system that activates white blood cells to protect against invaders. When the system doesn’t work correctly, it causes inflammation for unknown reasons. In addition to inflammation, auto-inflammatory diseases often cause fever and rashes”
The strange thing about this reaction is that it can happen in patients of all ages, from young children to elderly adults. Doctors are currently unaware of how and why this reaction occurs; while there have been many hypotheses on the subject, there are still no concrete answers.
What Are The Common Symptoms Of Rheumatoid Arthritis?
The most common symptom of all types of rheumatoid arthritis is persistent joint swelling, pain, and rigidity that is typically worse in the morning or after a nap. The pain may limit movement of the affected joint, commonly affects the knees and the joints in the hands and feet.
One of the earliest signs of RA may be limping in the morning because of an affected knee. Pleuritis (inflammation of the pleura, the membrane that covers the lungs) is a feature of some rheumatic disorders, including systemic arthritis.
Besides joint symptoms, patients may develop a fever and a skin rash, which may appear and disappear quickly.
Systemic arthritis may also cause swelling of the lymph nodes in the neck and other parts of the body. There are periods of time where symptoms appear to get better, and periods of time where they get worse.
In fewer than half of the cases, internal organs including the heart (pericarditis) and (very rarely) the lungs, may be involved.
Treatment Of Pericarditis and Rheumatoid Arthritis
Treatment with non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids and/or other immunosuppressive drugs is usual in the majority of patients with a definite diagnosis of Pericarditis and Rheumatoid Arthritis, and in severe cases, surgery (pericardiectomy) could be a solution.
All NSAIDs work similarly: by blocking substances called prostaglandins that contribute to inflammation and pain. However, each NSAID is a different chemical, and each has a different effect on the body, but they are often the first type of medication used. Consult a doctor before taking any of these medications.
Methotrexate Is Safe For Patients With Pericarditis and Rheumatoid Arthritis
Researchers have learned that methotrexate is safe and effective for patients whose symptoms are not relieved by other medications like NSAIDs; only small doses of methotrexate are needed to relieve arthritis symptoms, and potentially dangerous side effects rarely occur. The most serious complication is liver damage, but it can be avoided with regular blood tests and frequent follow up appointments. Careful monitoring for side effects is important for people taking methotrexate. When side effects are noticed early, the doctor can reduce the dose and eliminate the side effects.
Medication For Serious Symptoms Of Pericarditis and Rheumatoid Arthritis
Stronger medicines may be needed to stop serious symptoms such as inflammation of the sac around the heart (pericarditis). Corticosteroids such as Prednisone may be added to the treatment plan to control severe symptoms. This medication can be given either intravenously (directly into the vein) or by mouth.
Because of the severe side effects of corticosteroids, it’s important that patients are gradually weaned off of the medication instead of stopping it suddenly. Since stopping cold turkey can be dangerous, it’s important for patients to follow their doctor’s instructions on how to take or reduce their dosage. For inflammation in one or just a few joints, injecting a corticosteroid compound into the affected joint or joints can often bring quick relief without the systemic side effects of oral or intravenous medication.
Recent studies have suggested that anti-TNF-alpha therapy is effective in cases of constrictive pericarditis complicated with rheumatoid arthritis. These studies conclude that etanercept therapy seems to be highly effective in the anti-inflammatory treatment of constrictive pericarditis complicated with rheumatoid arthritis, and should be considered as an alternative to surgery.
Heart failure can occur or get worse in people who use TNF blockers. Your doctor will closely monitor you if you have heart failure. Tell your doctor right away if you get new or worsening symptoms of heart failure such as shortness of breath or swelling of your lower legs or feet.
Mortality Rates With Pericarditis and Rheumatoid Arthritis
Whether pericarditis itself contributes significantly to RA mortality is unknown, except in the few patients with constrictive pericarditis, or rapidly progressive effusive pericarditis, associated with a high mortality rate in rheumatoid arthritis.
The postmortem research of pericarditis incidence in patients with RA is reported to be in the range of 11 to 50%. During the last few decades, echocardiography has allowed the antemortem detection of pericardial effusions and other types of pericarditis in about a third of patients with RA. Nevertheless, symptomatic rheumatoid pericarditis with cardiac tamponade or constrictive pericarditis is uncommon. This research shows that 12 out of 960 patients (1.25%) admitted to a hospital over 11.5 years for complications of RA had clinically apparent pericarditis, and 5 of these 12 had cardiac tamponade.
Symptomatic rheumatoid pericarditis occurs most frequently in older patients, but the age of the patients with RA symptoms is variable. Because the pericardial fluid can be loculated and difficult to aspirate, pericardiocentesis should be reserved for relief of life-threatening cardiac tamponade. In the case of cardiac compression (constriction and tamponade) and chronic pericarditis, the preferred long-term treatment is pericardial resection. Visit here for further reading.
This article is intended to be informative, not to treat or recommend any treatment. If you are presenting symptoms of Pericarditis and Rheumatoid Arthritis as described above, you must consult with your physicians as soon as possible.