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A large chronic pericardial effusion in an ultramarathon runner with anti-CCP positive rheumatoid arthritis
  1. Thomas J McClelland1,
  2. Rose Penfold2,
  3. Stefan Kluzek2,
  4. Navraj S Nagra2
  1. 1Medical Sciences Division, University of Oxford, Oxford, UK
  2. 2Botnar Research Centre (NDORMS), University of Oxford, Oxford, UK
  1. Correspondence to Dr Navraj S Nagra, navraj.nagra{at}


Pericardial effusions arise as an extra-articular manifestation of rheumatoid arthritis (RA). Pericardial effusions are often asymptomatic, particularly in the early phase, but patients are at risk of cardiac tamponade as the effusion progresses. We discuss the case of a 40-year-old male ultramarathon runner with RA who presented with mild pleuritic chest pain and exertional dyspnoea after a recent long-haul flight. Despite a relative tachycardia, his observations were otherwise unremarkable. His blood tests revealed a C-reactive protein (CRP) of 86 mg/L and an anti-cyclic citrullinated peptide (anti-CCP) titre of 360 units/mL. He was initially diagnosed with a pulmonary embolism; however, a large pericardial effusion was found incidentally on CT pulmonary angiogram with over 1500 mL subsequently drained. The patient’s symptoms resolved and CRP normalised 2 weeks later. This unique case illustrates that physically fit patients may physiologically compensate for large pericardial effusions and that arthritic symptoms do not correlate with the severity of extra-articular features in RA.

  • emergency medicine
  • rheumatoid arthritis
  • sports and exercise medicine
  • cardiovascular medicine

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  • Contributors RP and SK were involved in the patient's care. TJM, RP, SK and NSN prepared and wrote the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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