Unmasking Atrioventricular Block in Rheumatoid Arthritis: A Case Report of a Rare Extra-Articular Involvement

Abstract

Rheumatoid arthritis is a systemic condition impacting not only joints but also various organs, with potential life-threatening consequences, particularly involving the heart. Pericardial damage is a prevalent cardiovascular manifestation that generally responds well to anti-inflammatory interventions. While atrioventricular block in RA is uncommon, it remains a possibility and poses a threat to vital prognosis in the absence of proper treatment. Despite the rarity of this manifestation, recognising and understanding the mechanisms underlying AVB in RA is crucial for timely diagnosis and appropriate management. The case of a young female patient with a 23-year history of rheumatoid arthritis, experiencing recurrent syncope episodes associated with complete atrioventricular block, was presented. The severity of the condition necessitated the implantation of a dual-chamber pacemaker. It was done 48 hours later, with uncomplicated postoperative monitoring. The patient was discharged after a 4-day hospital stay, with scheduled rhythmology follow-up. In order to address the left external malleolus fracture, orthopaedic treatment in the form of a cast boot was administered for six weeks, accompanied by oral preventive anticoagulation using apixaban (2.5 mg twice daily). It was noted that Pericarditis stands out as the most prevalent cardiovascular manifestation, affecting up to 30 to 50% of patients, depending on the series. This case holds significance due to the rarity of atrioventricular block in rheumatoid arthritis, its complex pathophysiology, and the essential reliance on cardiac stimulation for treatment, as anti-inflammatory interventions show limited efficacy in this particular scenario.