Abstract
Background Pericardial effusions in systemic sclerosis (SSc) may present as acute or chronic with or without clinical symptoms. Best treatment is unknown and whether patients receive medical therapy or a surgical procedure is clinician-dependent. Objective To describe the clinical characteristics, treatment, and outcomes of patients with SSc and clinically symptomatic pericardial effusions treated in the inpatient setting. Methods We evaluated all SSc admissions over a 10-year period to a tertiary care hospital which has a dedicated SSc clinic. Patients who had a clinically symptomatic pericardial effusion were evaluated based on their demographics, disease pattern, and medical or surgical management. Results From January 2005 till October 2015, there were 462 SSc admissions with 32 (6.9%) of them being for a clinically symptomatic pericardial effusion in 23 unique patients. Eleven (47%) of these patients had right heart failure, seventeen (74%) had pulmonary arterial hypertension (PAH), and 4 (17%) had tamponade physiology. Five (22%) patients were treated by a surgical procedure, while eighteen (78%) patients had medical therapy. Patients who received medical therapy tended to be older, have a lower serum Cr level, and more likely have right heart failure. Conclusion Clinically symptomatic pericardial effusion is a rare cause for hospital admissions in SSc, with a high percentage of these patients having PAH. Medical therapy tends to be reserved for older patients with right heart failure, while surgical therapy was more likely in patients with higher serum Cr levels.
Highlights
Systemic sclerosis (SSc) is an autoimmune rheumatic disease characterized by visceral and skin fibrosis, vascular dysfunction, and immune dysregulation
The present study describes the clinical manifestations, treatment, and outcomes of systemic sclerosis (SSc) patients who were admitted to the hospital with a clinically significant pericardial effusion
The decision-making for procedures in this group did not necessarily depend on the size of the pericardial effusion; while the two groups are small, some statistical comparisons were significant and in some cases there were some apparent trends among the two groups
Summary
Systemic sclerosis (SSc) is an autoimmune rheumatic disease characterized by visceral and skin fibrosis, vascular dysfunction, and immune dysregulation. Symptomatic pericardial effusions are present in only 5% to 16% of SSc patients [10,11,12,13]. Pericardial effusions in systemic sclerosis (SSc) may present as acute or chronic with or without clinical symptoms. Patients who had a clinically symptomatic pericardial effusion were evaluated based on their demographics, disease pattern, and medical or surgical management. Patients who received medical therapy tended to be older, have a lower serum Cr level, and more likely have right heart failure. Symptomatic pericardial effusion is a rare cause for hospital admissions in SSc, with a high percentage of these patients having PAH. Medical therapy tends to be reserved for older patients with right heart failure, while surgical therapy was more likely in patients with higher serum Cr levels
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