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A 75-year-old man presented with progressive dyspnoea. There was a 24-year history of severe deforming rheumatoid arthritis for which he had required a number of disease modifying therapies. At the time of admission his symptoms were controlled on non-steroidal anti-inflammatory drugs (NSAIDs) and prednisolone. He had no clinical signs of cardiac tamponade on presentation; however, a chest …