Pleurisy and Pericarditis - Acute Manifestations of Rheumatoid Arthritis in the Elderly With Rapid Onset

Elderly-onset rheumatoid arthritis (EORA) is a distinct clinical entity of Rheumatoid Arthritis (RA), which begins after the age of 60 years, and which is distinguished by its clinical features from young-onset rheumatoid arthritis (YORA).

This case report aims to highlight the importance of increased vigilance, because in many cases EORA can begin with pulmonary, cardiological, dermatological, but also locomotor lesions.

We present an excellent case of a 68-year-old male patient, a heavy and long-term tobacco user, with arterial hypertension, dyslipidemia, with a rapid onset of the disease. Pleurisy, pericarditis, rheumatoid joints, pannus and later synovitis were its explosive clinical picture. Due to the presence of pleurisy and pericarditis, but also high nonspecific inflammatory parameters, the clinical situation was an acute case and rapid diagnosis was a clinical challenge. Based on the clinical picture, inflammatory, serological and radiological parameters, the patient was diagnosed with EORA. The treatment started with DMARDs, glucocorticoids, antihypertensives and antilipemics and there was a good response with regression of the clinical picture.

Although the patient was old, with chronic diseases and with a weakened immunity due to external factors, treatment with Methotrexate, Glucocorticoids in small doses and antihypertensives for 10 days. This treatment achieved a great improvement in the clinical picture and a decrease in the inflammatory activity of EORA.

The onset of a disease with pleurisy, pericarditis and delayed appearance of synovitis, associated with high inflammatory parameters is one of the variants of the presentation of EORA.