Cardiac tamponade in juvenile rheumatoid arthritis.

I was interested to read the paper by Majeed and Kvasnicka (1978) on cardiac tamponade in a patient with juvenile rheumatoid arthritis. The final comment is that it is difficult to judge the value of local corticosteroid injections after pericardiocentesis, but they quote the paper of Scharf et al. (1976) in which the effect of local corticosteroid was dramatic. The authors have overlooked a recent case report (Richards et al., 1976) of an adult with seropositive nodular rheumatoid arthritis whose pericardial effusion cleared promptly following pericardiocentesis and intrapericardial steroids. Immunological data from that patient supported the concept of local production of immune complexes in the pericardial cavity. Might I suggest that if their patient develops another large pericardial effusion, they give in the first instance local corticosteroids after pericardiocentesis rather than systemic corticosteroids?