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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\u2019s 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.<\/jats:p>","DOI":"10.1136\/bcr-2017-219350","type":"journal-article","created":{"date-parts":[[2017,6,13]],"date-time":"2017-06-13T03:30:22Z","timestamp":1497324622000},"page":"bcr-2017-219350","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["A large chronic pericardial effusion in an ultramarathon runner with anti-CCP positive rheumatoid arthritis"],"prefix":"10.1136","volume":"2017","author":[{"given":"Thomas J","family":"McClelland","sequence":"first","affiliation":[{"name":"Medical Sciences Division, University of Oxford, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rose","family":"Penfold","sequence":"additional","affiliation":[{"name":"Botnar Research Centre (NDORMS), University of Oxford, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Kluzek","sequence":"additional","affiliation":[{"name":"Botnar Research Centre (NDORMS), University of Oxford, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Navraj S","family":"Nagra","sequence":"additional","affiliation":[{"name":"Botnar Research Centre (NDORMS), University of Oxford, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,6,13]]},"reference":[{"key":"2025082801041947000_2017.jun12_1.bcr-2017-219350.1","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0b013e32835f693f"},{"key":"2025082801041947000_2017.jun12_1.bcr-2017-219350.2","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(200104)45:2<129::AID-ANR164>3.0.CO;2-K"},{"key":"2025082801041947000_2017.jun12_1.bcr-2017-219350.3","doi-asserted-by":"crossref","unstructured":"Soler-Soler J , Permanyer-Miralda G S-S . 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