Rheumatic Pericarditis: Understanding Its Clinical Presentation

Rheumatic pericarditis is a condition that often emerges during an acute episode of rheumatic fever or during its exacerbation phase. During this time, the pericardium may accumulate fibrinous, serofibrinous, or purulent exudate. Despite these pathological changes, the pericardial reaction typically resolves on its own without long-term complications.

Pathophysiology and Immune Mechanisms

Although the condition may lead to temporary pericardial effusion, the likelihood of developing chronic complications such as pericardial thickening, calcification, or constriction is quite rare. One notable feature of rheumatic pericarditis is the presence of immune complex deposition — specifically, immunoglobulins like IgG and IgM along with complement components — on the pericardial surface. This finding has led researchers to believe that an autoimmune response plays a significant role in the disease process.

Clinical Features and Symptomatology

Patients with rheumatic pericarditis often present with the classic signs of acute rheumatic fever. These include systemic symptoms such as fever, generalized weakness, and arthralgia affecting multiple joints. In addition to these manifestations, pericardial involvement introduces specific cardiovascular symptoms.

One of the hallmark signs of pericarditis is pleuritic chest pain, which typically worsens with deep inspiration or lying down and improves when sitting up or leaning forward. Physicians may also detect a pericardial friction rub during physical examination — a characteristic auscultatory finding that confirms pericardial inflammation.

Prognosis and Disease Course

The symptoms associated with rheumatic pericarditis are generally self-limiting, resolving within days to weeks without specific intervention. As the inflammatory process subsides, the accumulated fluid is gradually absorbed, and the pericardium typically returns to its normal state in most cases. However, close clinical monitoring is recommended to ensure complete recovery and to rule out potential cardiac complications.