Rheumatoid arthritis (RA) may include rare extra-articular manifestations, and particularly cardiopulmonary involvement. We report a 83-year-old woman, with RA, who presented with both pulmonary and heart failures that were related to the RA, resulting from the presence of mediastinal and axillary lymph nodes, and pleural and pericardial effusions. This was confirmed by the dramatic improvement after a specific treatment of RA.