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Sudden Flare of Rheumatoid Arthritis Associated with Newly Diagnosed Atrial Flutter

We present an 89-year-old woman with newly diagnosed atrial flutter associated with a flare of her rheumatoid arthritis (RA). She had a history of diet-controlled type 2 diabetes mellitus, hypertension, and RA and presented with lightheadedness and worsening hand pain. She was found to be in new atrial flutter with rapid ventricular response and to have an active RA flare. In addition to adequate atrial flutter rate control, her RA flare was managed by adding hydroxychloroquine and doubling her existing methotrexate dose.