A 24-year-old woman with bilateral pulmonary infiltrates, pericardial effusion, and bilateral pleural effusions.

1. RA flares may present with multiorgan involvement without exacerbation of articular symptoms.

2. Bilateral, patchy, alveolar pulmonary infiltrates on chest radiography in patient with RA should suggest organizing pneumonia.

3. One should consider RA or other connective tissue disease in a patient presenting with pleuropericardial effusion and bilateral pulmonary infiltrates, as cardiopulmonary manifestations may rarely precede the arthritis.

4. Organizing pneumonia secondary to RA typically has a good response to corticosteroids.