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Case Reports
. 2024 Oct 2;29(19):102570.
doi: 10.1016/j.jaccas.2024.102570.

Unveiling Rheumatoid Arthritis: Recurrent Pericarditis as the Sentinel Manifestation

Muhammad Majid  1   2 , Ankit Agrawal  1 , Aro Daniela Arockiam  1 , Akiva Rosenzveig  1 , Ashwin Kumar  1 , Jaideep Singh Bhalla  1 , Muhammad Sohaib Asghar  2 , Thomas Shimshak  2 , Chad Brands  2 , Allan L Klein  1
Affiliations
Case Reports

Unveiling Rheumatoid Arthritis: Recurrent Pericarditis as the Sentinel Manifestation

Muhammad Majid et al. JACC Case Rep. .

Abstract

A 69-year-old man presented with corticosteroid-dependent colchicine-resistant chronic recurrent pericarditis initially thought to be idiopathic in etiology. Transitioning from anakinra to rilonacept revealed rheumatoid arthritis as the underlying cause. Anakinra demonstrated superior efficacy in managing both pericarditis and rheumatoid arthritis symptoms.

Keywords: IL-1 blockers; anakinra; cardiac magnetic resonance imaging; recurrent pericarditis; rheumatoid arthritis; rilonacept; transthoracic echocardiography.

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Conflict of interest statement

Dr Klein has received research funding from Kiniksa Pharmaceuticals, Ltd and Cardiol Therapeutics; and has served on Scientific Advisory Boards for Kiniksa Pharmaceuticals, Ltd, Swedish Orphan Biovitrum AB, Cardiol Therapeutics, and Pfizer, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Diagram Demonstrating the Patient’s Treatment Course and Eventual Diagnosis of Rheumatoid Arthritis ED = emergency department.
Figure 2
Figure 2
Multimodality Imaging Assessment of Index Pericarditis and Recurrence Off Anakinra Baseline transthoracic echocardiogram demonstrating (A, B) a small pericardial effusion, (C, D) annulus reversus, (E, F) and no significant respiratory variation through the mitral and tricuspid valves. Serial cardiac magnetic resonance imaging with late gadolinium enhancement demonstrating (G) severe pericardial inflammation, (H) significant improvement after anakinra initiation, (I) recurrence of severe pericardial inflammation after sudden anakinra withdrawal, and (J) significant improvement after recommencement of anakinra. MV = mitral valve; TDI = tissue Doppler imaging; TV = tricuspid valve.
Figure 3
Figure 3
Multimodality Imaging Demonstrating Resolution After Anakinra Initiation (A, B) Follow-up transthoracic echocardiogram shows no pericardial effusion, (C, D) no annulus reversus, and no respirophasic variation across the (E) mitral and (F) tricuspid valve. (G, H) Follow-up cardiac magnetic resonance imaging showing continuous decrease in the late pericardial gadolinium enhancement. Abbreviations as in Figure 2.
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References

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