Objectives: The aim of this study was to determine the frequency and clinical correlates of asymptomatic pericardial effusion (PE) detected by echocardiography in patients with rheumatoid arthritis (RA). Methods: Echocardiography and electrocardiography were performed in 87 consecutive patients with RA. Asymptomatic PE was correlated with electrocardiographic changes and laboratory findings. Results: Among 87 patients with RA, 20 patients (23%) had PE and 28 patients (32%) had hypoalbuminemia. The patients with PE had significantly lower serum albumin level (p < 0.001), higher rheumatoid factor (RF)titer (p = 0.002) and higher incidence of impaired left ventricular relaxation (55 vs. 28%, p = 0.028) and tended to have a higher incidence of PR-segment depression than those without PE (p = 0.085). When five variables (PR-segment depression, C-reactive protein, serum albumin, RF and impaired left ventricular relaxation) were used in the multivariate analysis, serum albumin (p = 0.003, Odds ratio = 0.131) and RF (p = 0.020, Odds ratio = 3.775) emerged as significant variables related to the presence of asymptomatic PE. Conclusions: In addition to pericardial inflammation due to more severe RA, hypoalbuminemia was an important factor associated with the presence of asymptomatic PE.

Prakash R, Atassi A, Poske R, Rosen KM: Prevalence of pericardial effusion and mitral valve involvement in patients with rheumatoid arthritis without cardiac symptoms. N Engl J Med 1973;289:597–600.
Corrao S, Salli L, Arnone S, Scaglione R, Amato V, Cecala M, Licata A, Licata G: Cardiac involvement in rheumatoid arthritis: evidence of silent heart disease. Eur Heart J 1995;16:253–256.
Guedes C, Bianchi-Fior P, Cormier B, Barthelemy B, Rat A, Boissier M: Cardiac manifestations of rheumatoid arthritis: a case-control transesophageal echocardiography study in 30 patients. Arthritis Care Res 2001;45:129–135.
Kitas G, Banks MJ, Bacon PA: Cardiac involvement in rheumatoid disease. Clin Med 2001;1:18–21.
Maione S, Valentini G, Giunta A, Tirri R, Giacummo A, Lippolis C, Arnese M, Paulis A, Marone G, Tirri G: Cardiac involvement in rheumatoid arthritis: an echocardiographic study. Cardiology 1993;83:234–239.
Spodick DH: The normal and diseased pericardium: current concepts of pericardial physiology, diagnosis and treatment. J Am Coll Cardiol 1983;1:240–251.
Spodick DH: Pericardial Involvement in Disease of the Heart and Other Contiguous Structures. The Pericardium. A Comprehensive Textbook. New York, Marcel Dekker Inc., 1997, pp 126–152.
Gabay C, Kushner I: Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999;340:448–455.
Wilkinson P, Jeremy R, Brooks FP, Hollander JL: The mechanism of hypoalbuminemia in rheumatoid arthritis. Ann Intern Med 1965;63:109–114.
Niwa Y, Iio A, Niwa G, Sakane T, Tsunematsu T, Kanoh T: Serum albumin metabolism in rheumatic diseases: relationship to corticosteroids and peptic ulcer. J Clin Lab Immunol 1990;31:11–16.
Roubenoff R, Roubenoff RA, Cannon JG, Kehayias JJ, Zhuang H, Dawson-Hughes B, Dinarello CC, Rosenberg IH: Rheumatoid cachexia: cytokine-driven hypermetabolism accompanying reduced body cell mass in chronic inflammation. J Clin Invest 1994;93:2379–2386.
Rall LC, Rosen CJ, Dolnikowski G, Hartman WJ, Lundgren N, Abad LW, Dinarello AC, Roubenoff R: Protein metabolism in rheumatoid arthritis and aging. Arthritis Rheum 1996;39:1115–1124.
Fukuda W, Yamazaki T, Akaogi T, Hayashi H, Kusakabe T, Tsubouchi Y, Kawahito Y, Inoue M, Yoshikawa T: Malnutrition and disease progression in patients with rheumatoid arthritis. Mod Rheumatol 2005;15:104–107.
Arnett FC, Edworthy SM, Bloch DA, Mcshane RJ, Fries JF, Cooper NS: The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988;31:315–324.
Nitta S, Ohnuki T, Ohkuda K, Nakada T, Staub NC: The corrected protein equation to estimate plasma colloid osmotic pressure and its development on a nomogram. Tohoku J Exp Med 1981;135:43–49.
Staub NC: Pathophysiology of pulmonary edema; in Staub NC, Taylor AE (eds): Edema. New York, NY, Raven Press, 1984, pp 719–746.
Henry WL, Gardin JM, Ware JH: Echocardiographic measurements in normal subjects from infancy to old age. Circulation 1980;62:1054–1060.
Horowitz MS, Schultz CS, Stinson EB, Harrisom DC, Popp RD: Sensitivity and specificity of echocardiographic diagnosis of pericardial effusion. Circulation 1974;50:239–247.
Weitzman LB, Tinker WP, Kronzon I, Cohen ML, Glassman E, Spencer FC: The incidence and natural history of pericardial effusion after cardiac surgery. An echocardiographic study. Circulation 1984;69:506–511.
Miller AJ, Pick R, Johnson PJ: The production of acute pericardial effusion: The effects of various degrees of interference with venous blood and lymph drainage from the heart muscle in the dog. Am J Cardiol 1971;28:463–466.
Braunwald E: Edema; in Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL (eds): Harrison’s Principles of Internal Medicine, ed 15. New York, NY, McGraw-Hill, 2001, pp 217–222.
Bruce ME, Spodick DH: Atypical electrocardiogram in acute pericarditis: characteristics and prevalence. J Electrocardiol 1980;13:61–66.
Spodick DH: Diagnostic electrocardiographic sequences in acute pericarditis. Circulation 1973;48:575–580.
Spodick DH: Electrocardiogram in acute pericarditis. Distribution of morphologic and axial changes by stages. Am J Cardiol 1974;33:470–474.
Kudo Y, Yamasaki F, Doi Y, Sugiura T: Clinical correlates of PR-segment depression in asymptomatic patients with pericardial effusion. J Am Coll Cardiol 2002;39:2000–2004.
Wolfe F, Mitchell DM, Sibley JT, Fries JF, Bloch DA, Williams CA, Spitz PW, Haga M, Kleinheksel SM, Cathey MA: The mortality of rheumatoid arthritis. Arthritis Rheum 1994;37:481–494.
Vencovsky J, Machacek S, Sedova L, Kafkova J, Gatterova J, Pesakova V, Ruzickova S: Autoantibodies can be prognostic markers of an erosive disease in early rheumatoid arthritis. Ann Rheum Dis 2003;62:427–430.
Voskuyl AE, Zwinderman AH, Westedt ML, Vandenbroucke JP, Breedveld FV, Hazes JM: Factors associated with the development of vasculitis in rheumatoid arthritis: results of a case-control study. Ann Rheum Dis 1996;55:190–192.
Voskuyl AE, Hazes JMW, Zwinderman AH, Paleolog EM, Meer FJ, Daha MR, Breedveld FC: Diagnostic strategy for the assessment of rheumatoid vasculitis. Ann Rheum Dis 2003;62:407–413.
Spodick DH: Pericardial Disease in the Vasculitis-Connective Tissue Disease Group. The Pericardium. A Comprehensive Textbook. New York, Marcel Dekker Inc., 1997, pp 314–333.
Dorner T, Egerer K, Feist E, Burmester GR: Rheumatoid factor revisited. Curr Opin Rhematol 2004;16:246–253.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.