Cardiac tamponade secondary to steroid decrease administration

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Abstract

Although characteristically a joint disease, rheumatoid arthritis (RA) can affect a number of other tissues. The extraarticular manifestations probably occur with considerable frequency, but are usually occult and with limited clinical significance. Occasionally, however, the extraarticular events dominate the clinical picture. Pericardial disease is the most common cardiac lesion in patients with RA. It seems that echocardiography is the most sensitive method for its diagnosis (30%- 50% of patients). Although clinical diagnosis may be difficult, it can be found in 2%-10% of such patients. We now report a case of cardiac involvement in a patient with a 25 years history of erosive rheumatoid of erosive rheumatoid arthritis, who developed severe haemodinamic failure secondary to cardiac tamponade following sudden steroid decrease. We review the classical clinical features of cardiac tamponade and their medical and surgical treatment. This syndrome may have severe consequences such as recurrence, or its evolution to constrictive pericarditis. Two pericardiocentesis were performed withouth success. Pericardiectomy had been offered to avoid recidive. The cardiac involvement should be carefully considered in each patient, to choose the treatment afterwards. Although oral corticosteroid therapy may be effective in selected cases, pericardiectomy is indicated to patients with good prognosis, but in patients with terminal disease pericardiotomy may be offered as an alternative procedure.