ABSTRACT
Undifferentiated connective tissue disease (UCTD) is a condition characterized by symptoms and laboratory findings related to various systematic autoimmune diseases. Severe symptoms like chest pain in patients with UCTD could suggest an underlying secondary condition, such as pericarditis. Our case involves a 36-year-old woman with a history of UCTD and recently diagnosed rheumatoid arthritis (RA) who presented with persistent sub-sternal chest pain and pressure that began three weeks ago. Over the past year, she experienced six similar episodes of chest pain, diagnosed as idiopathic pericarditis. She promptly underwent treatment with oral prednisone and was instructed to continue her current medications (colchicine, methotrexate, and Plaquenil). Subsequent laboratory results, obtained several days posttreatment, revealed an elevated C-reactive protein (CRP), normal erythrocyte sedimentation rate (ESR), an elevated rheumatoid factor, and a normal echocardiogram, suggesting resolution of the acute flare. Despite having a comprehensive treatment regimen, the patient continues to experience recurrent pericarditis episodes. The cause of the recurrence remains uncertain, potentially associated with repeated use of high-dose steroids and a recent diagnosis of RA. Consequently, her rheumatologist opted to initiate treatment with intravenous Golimumab to better manage the RA and potentially address recurrent pericarditis. Physicians should maintain a heightened clinical suspicion of pericarditis in UCTD patients experiencing chest pain, as initiating prompt treatment helps prevent long-term complications and can be lifesaving in certain instances.
