doi: 10.5606/tjr.2012.009 Turk J Rheumatol 2012;27(1):67-69 Case Report Rheumatoid Arthritis: A Rare Cause of Cardiac Tamponade Kardiyak Tamponadın Nadir Bir Nedeni: Romatoid Artrit Yiğit ÇANGA, Kazım Serhan ÖZCAN, Mehmet Baran KARATAŞ, Gündüz DURMUŞ, İzzet Celal ERDİNLER Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, İstanbul, Turkey Received: December 18, 2010 Accepted: June 6, 2011 Correspondence: Kazım Serhan Özcan, M.D. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi Kardiyoloji Kliniği, 34726 Üsküdar, İstanbul, Turkey. Tel: +90 216 - 545 47 36 e-mail: serhandr@gmail.com ©2012 Turkish League Against Rheumatism. All rights reserved. Romatoid artrit (RA) toplumun yaklaşık %1’inde görülen, nedeni bilinmeyen, multisistem tutulumlu kronik bir hastalıktır. Hastalığın tipik özelliği genellikle periferik eklemleri simetrik dağılımlı olarak tutan persistan inflamatuar sinovittir. Romatoid artritin sistemik tutulumları perikardit, plörit, vaskülit, tuzak nöropatisi, interstisyel akciğer hastalığı, Sjogren ve Felty sendromlarıdır. Hastaların yaklaşık %50’sinde RA’nın perikardı etkilediği, ekokardiyografik ve postmortem çalışmalarda gösterilmiştir. Buna rağmen, kardiyak tamponad RA’nın nadir bir komplikasyonudur. Bu yazıda, cerrahi olarak tedavi edilmiş olan kardiyak tamponada neden olan loküle perikardiyal effüzyonlu 61 yaşında bir kadın hasta sunuldu. Anahtar sözcükler: Kardiyak tamponad; perikardiyal effüzyon; perikard; romatoid artrit. Rheumatoid arthritis (RA) is a chronic multisystem disease of unknown cause which affects approximately 1% of the population. The typical characteristic of RA is persistent inflammatory synovitis which usually involves peripheral joints in a symmetric distribution. Systemic involvements of RA include pericarditis, pleuritis, vasculitis, entrapment neuropathy, interstitial lung disease and Sjogren and Felty syndromes. Echocardiographic and postmortem studies have shown that RA affects pericardium in nearly 50% of the patients. However, cardiac tamponade is a rare complication of RA. In this report, we present a surgically-treated 61-year-old female patient with cardiac tamponade secondary to loculated pericardial effusion. Key words: Cardiac tamponade; pericardial effusion; pericardium; rheumatoid arthritis. Rheumatoid arthritis (RA) is a chronic multisystem disease of unknown cause which affects approximately 1 to 3% of the population. The characteristic feature of RA is persistent inflammatory synovitis, usually involving peripheral joints in a symmetric distribution. Systemic involvements of RA include pericarditis, pleuritis, vasculitis, entrapment neuropathy, interstitial lung disease, and Sjogren’s and Felty syndromes. As indicated by echocardiography and necropsy studies, RA affects the pericardium in approximately 50 percent of patients. [1] Chronic asymptomatic pericardial effusion is more common than acute pericarditis. [2] Cardiac tamponade is a rare complication of RA. In this report, we describe a surgically treated female patient with cardiac tamponade secondary to loculated pericardial effusion. CASE REPORT Our case involved a 61-year-old female patient who had been diagnosed with seropositive and erosive RA 20 years previously. She had no extraarticular involvement and was using oral methotrexate 15 mg once a week. The patient was admitted to another hospital having complained of progressive dyspnea, chest pain, and lower leg edema for more than 10 days. Pericardial effusion was detected by a thoracoabdominal computed tomography (CT) scan, and she was transferred to our hospital. At arrival, physical examination showed an arterial pressure of 110/70 mmHg, a pulse rate of 120 beats/min, a respiratory rate of 30/min, and a body temperature of 37 °C with distended neck veins, mild hepatomegaly, and decreased heart