A 48 year old male patient with longlasting RA was admitted because of general malaise, dyspnoea, oedema, pleural and pericardial effusions, increased creatinine and liver enzymes, leucocytopenia, thrombocytopenia, decreased C4 and CH50, and increased levels of circulating immune complexes. The diagnosis of RV was established. The patient’s condition did not sufficiently improve after treatment with steroid pulses, high dose CYC, or even plasmapheresis. He developed a life threatening heart failure caused by a “swinging heart” due to the pericardial effusion, which required immediate and repeated drainage (fig 1). As a last resort we decided to start infliximab treatment at 3 mg/kg. After the first infusion his condition improved rapidly and the pericardial effusion, in particular, disappeared within two weeks. All laboratory findings returned to normal. He continues to receive infliximab every eight weeks and is in good clinical condition. Even the activity of his RA, previously not sufficiently controlled by methotrexate alone, has decreased significantly.