[Acute congestive heart failure due to malignant rheumatoid arthritis]

A 54-year-old woman with malignant rheumatoid arthritis was admitted with acute congestive heart failure and pulmonary hypertension. The precipitating antibody to nuclear ribonucleoprotein (nRNP) was highly positive. Her hands and feet showed typical rheumatoid deformities and Raynaud's phenomenon. In a few days her feet became to necrosis due to vasculitis. "Pulse" methylprednisolone and prednisone therapy resulted in normalization of seropositivity, and left ventricular ejection fraction with symptoms of congestive heart failure, and the elimination of ECG abnormalities. Recognition of symptoms of left ventricular dysfunction in patients with rheumatoid arthritis should prompt testing for active arteritis and/or myocarditis, because dramatic improvement may result from immunosuppressive therapy.