Constrictive pericarditis requiring pericardiectomy: an unusual first presentation of extra-articular rheumatoid arthritis-a case report.

Significant pericardial constriction can occur as the initial presentation of rheumatoid disease and anti-CCP is a highly specific confirmatory test. Pericardial pathological specimen can be unhelpful in determining this aetiology, and constrictive physiology can occur due to chronic inflammation/fibrosis in the absence of significant calcification.