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Complete Atrioventricular (AV) Block as a Cardiac Complication of Rheumatoid Arthritis: A Rare Case Report
Christian Johan1, Fatih Anfasa2, Adityo Susilo3
1Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia. cjohan8@yahoo.com.
Acta Medica Indonesiana
|October 6, 2025
Summary
Rheumatoid arthritis (RA) can cause complete atrioventricular block (AVB), a rare but serious heart complication. Early recognition and treatment with pacemakers and anti-inflammatory drugs are crucial for managing this RA manifestation.
Area of Science:
- Cardiology
- Rheumatology
- Immunology
Background:
- Rheumatoid arthritis (RA) is a chronic autoimmune disease primarily affecting joints.
- Cardiac involvement in RA typically includes pericardial effusion, heart failure, myocarditis, and coronary artery disease.
- Complete atrioventricular block (AVB) is an uncommon but significant extra-articular manifestation of RA.
Purpose of the Study:
- To report a case of complete AVB in a patient with rheumatoid arthritis.
- To highlight the importance of recognizing and managing this rare cardiac complication of RA.
- To discuss the diagnostic and therapeutic approaches for AVB in the context of RA.
Main Methods:
- Case presentation of a 48-year-old woman with RA and symptoms of dyspnea and peripheral edema.
- Diagnostic workup including physical examination, electrocardiography (ECG), and thoracic computed tomography (CT) scan.
- Laboratory tests to assess inflammatory markers (C-reactive protein, rheumatoid factor, cytokines).
Main Results:
- The patient presented with bradycardia, polyarthritis, and finger deformities consistent with RA.
- ECG confirmed complete AVB; thoracic CT revealed lung fibrosis and bronchiectasis.
- Elevated inflammatory markers were observed; treatment included pacemaker placement and pharmacological therapy (methylprednisolone, tocilizumab).
Conclusions:
- Complete AVB is a rare but critical cardiovascular complication of rheumatoid arthritis.
- Early diagnosis and prompt management involving pacemakers, anti-inflammatory drugs, and disease-modifying antirheumatic drugs are essential.
- This case underscores the need for vigilance regarding cardiac involvement in RA patients.
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