# A Case Report: Unveiling the Underlying Cause of Recurrent Pericarditis in a Patient With Undifferentiated Connective Tissue Disease

## TL;DR

A 36-year-old woman with UCTD and RA experiences recurrent pericarditis, prompting a new treatment approach with Golimumab.

## Contribution

Highlights the potential link between RA and recurrent pericarditis in UCTD patients and the use of Golimumab as a treatment strategy.

## Key findings

- The patient's recurrent pericarditis episodes may be linked to her recent RA diagnosis.
- Treatment with intravenous Golimumab was initiated to manage RA and potentially reduce pericarditis recurrence.
- Prompt diagnosis and treatment of pericarditis in UCTD patients can prevent serious complications.

## 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.