RHEUMATOID ARTHRITIS MEETS RHEUMATIC HEART DISEASE: A MULTISYSTEM COLLISION CREATING THERAPEUTIC ROADBLOCKS

Rheumatoid arthritis (RA) is a chronic autoimmune disorder with systemic manifestations, and its coexistence with rheumatic heart disease (RHD) presents unique clinical challenges. We describe a middle-aged woman with established RA who developed severe rheumatic mitral regurgitation with pulmonary hypertension, alongside renal dysfunction and pulmonary fibrosis. Management was complicated by contraindications to conventional DMARDs: hydroxychloroquine was withdrawn due to QT prolongation, and methotrexate was avoided owing to fibrotic lung changes, leaving sulfasalazine as the preferred alternative. She was subsequently referred for surgical valve replacement. This case underscores the complexity of treating RA patients with overlapping cardiovascular and pulmonary disease, where standard therapies may be restricted. It highlights the importance of early cardiac evaluation in symptomatic patients and calls for further research into safer, tailored immunomodulatory strategies for individuals with multi-organ involvement.