Is It a Heart Attack? Rheumatoid Arthritis and Pericarditis
Inflammation that is characteristic of rheumatoid arthritis (RA) doesn't only affect your joints; it targets internal organs as well, such as the heart. This can lead to a condition called pericarditis, which causes symptoms similar to a heart attack.
Pericarditis has been linked more to systemic lupus erythematosus, but also plays a role in rheumatoid arthritis. Some sources estimate that this heart problem affects up to 30 percent of patients with rheumatoid arthritis, but only a smaller percentage may actually develop symptoms.
According to a report published in the British Medical Journal, pericarditis doesn't seem to be related to how long you have rheumatoid arthritis, but the number of affected joints may be a factor.
Men in their 40s who have rheumatoid arthritis are most likely to develop this heart condition. However, because three times more women than men develop RA, they are also at risk for pericarditis.
What is Pericarditis?
The American Heart Association (AHA) describes this heart condition as inflammation of the pericardium, a thin sac that surrounds the heart and the roots of the great blood vessels.
The pericardium consists of an inner and outer layer with lubricating fluid between the two. Pericarditis causes the fluid between the two layers to increase, which puts pressures on the heart and interferes with how it functions.
In people with rheumatoid arthritis, pericarditis is more likely to occur when the disease is active. It can lead to serious heart complications such as:
- pericardial effusion - excess amount of fluid around the heart;
- cardiac ischemia - an obstruction of blood flow in the heart;
- cardiac tamponade - fluid buildup in the space between the myocardium, which is the muscle of the heart;
- chronic constrictive pericarditis - formation of scar tissue and lesions in the pericardium, which compresses the heart.
Symptoms of Pericarditis in Rheumatoid Arthritis
If fluid builds up slowly in the pericardium, you may not experience symptoms. In acute cases of pericarditis warning signs include chest pain. According to the Mayo Clinic, acute pericarditis may cause sharp, stabbing chest pain. This pain can occur below the breastbone, left side of the chest, or in the upper back and may mimic a heart attack.
In some situations, chest pain may be more like a dull ache or pressure that can vary in intensity.
- Difficulty breathing and coughing
- Fluid buildup in the abdomen or legs
Treatment for Pericarditis
Usually, acute pericarditis will last only about two to three weeks. Because it may trigger heart problems such as cardiac ischemia (an obstruction of blood flow in the heart), cardiac tamponade, or pericardial effusion, it needs to be treated immediately. These conditions can lead to heart failure and even death.
If you have rheumatoid arthritis and experience any of the above symptoms, you should see your doctor right away. You may need to have one (or more) of the following treatments:
• Non-steroidal anti-inflammatory drugs (NSAIDs). In most cases, NSAIDs such as aspirin or ibuprofen can effectively reduce inflammation and treat pain in pericarditis.
• Antibiotics. If a bacterial infection causes the heart condition when you have rheumatoid arthritis, you may need to take antibiotics.
• Colcichine. According to the Mayo Clinic, this drug which reduces inflammation throughout the body may be prescribed to fight pericarditis.
• Steroids. These drugs that are also used to treat rheumatoid arthritis, such as prednisone, also help to reduce inflammation in your body.
• Surgical procedures. A needle can be inserted to remove excessive fluid buildup. If pericarditis is more advanced, surgery to remove part of the pericardium may be necessary, but this is extremely rare.
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